Reversal Removal of Lepirudin

Bleeding is an important and potentially severe consequence of hirudin treatment (Antman, 1994; Neuhaus et al., 1994; Frank et al., 1999; Lubenow et al., 2005). As with all DTIs, no specific antidote is available. In a patient with minor bleeding and normal renal function, stopping the drug may be sufficient, since the drug concentration drops quickly. However, when bleeding is life-threatening or the patient has renal failure, cessation alone may not be adequate.

Hemodialysis or hemofiltration can reduce plasma levels of lepirudin (Riess et al., 1995). However, only some filters are effective, e.g., polysulfone F80 (Fresenius, Germany) (Frank et al., 1999; Bucha et al., 1999). Variable efficacy of filters in removing lepirudin could explain conflicting results (Vanholder et al., 1997). Clinical data are limited, and hemofiltration is not always a practical option in emergency situations.

Hirudin overdosage may also be treated pharmacologically by administration of desmopressin (Ibbotson et al., 1991; Butler et al., 1993; Bove et al., 1996), or von Willebrand factor (vWF), or vWF-containing factor VIII concentrates (Dickneite et al., 1996, 1998). Irami and coworkers (1995) described a patient in whom r-hirudin induced bleeding was treated by administration of prothrombin complex concentrates, a method previously used in animal models (Diehl et al., 1995). However, since these concentrates can contain heparin, they could be dangerous for a patient with acute HIT. Recombinant factor Vila is another "panhemostatic" treatment option (Oh et al., 2006). Meizothrombin could also be a potential antidote, but it is not available for use in humans (Nowak and Bucha, 1995).

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    Can medically induced ITP be reversed bt stopping the medication?
    2 years ago

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