Hirudin was the first anticoagulant to be used for hemodialysis, as performed by Haas (1924) in Germany. Because native hirudin preparations were crude and supply of leeches insufficient, hirudin was replaced by heparin to prevent clotting during dialysis.

Management of these patients requires careful dosing and frequent monitoring. HIT patients with transient renal failure are difficult to manage with lepir-udin, because substantial dose adjustments are necessary, depending on the extent of renal failure. To reduce bleeding risk, we prefer administering a continuous iv infusion, starting at 0.005 mg/kg/h, with adjustments made according to the aPTT, while others use intermittent iv boluses of 0.005-0.01 mg/kg (Fischer et al., 1999; Kern et al., 1999). Use of lepirudin in renal replacement therapy is reviewed in Chapter 18.

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