Dose Adjustments

In lepirudin-treated patients, laboratory values to monitor the anticoagulant effect should be obtained prior to treatment, 4 h after the start of iv infusion, and then every 4 h until a steady state is reached (Lubenow et al., 2004, 2005) (Fig. 2). Also, 4 h after every change in dose, monitoring should be repeated. For most patients, the primary laboratory parameter used is the aPTT, with testing performed at least once daily during treatment with lepirudin. If the target range is exceeded, the infusion should be stopped for 2 h and restarted at a 50% lower dose once the therapeutic range has been reached (Greinacher et al., 1999a,b). When the dose is subtherapeutic, the infusion rate should be increased by 20%.

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