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FIGURE 7 A 53-yr-old woman was admitted to the hospital because of an ankle fracture. She received low molecular weight heparin for 10 days, but was switched to unfractionated heparin because of a distal DVT. Ten days later she presented with proximal DVT, pulmonary embolism, and a rapid fall in platelet count from more than 200 to 12 x 109/L. She was switched to iv lepirudin (schedule Al). After normalization of platelet counts, she received overlapping oral anticoagulation (phenprocoumon), with lepirudin stopped when the INR reached 2.0. Antihirudin antibodies were first detected on day 7; at the same time, the aPTT increased despite a stable hirudin dosage of 0.05 mg/kg b.w. per hour. Abbreviations: aPTT, activated partial thromboplastin time; DVT, deep vein thrombosis; iv, intravenous; INR, international normalized ratio.

Anti-hirudin antibodies

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