Lepirudin Treatment In Other Clinical Settings A Acss and Percutaneous Coronary Intervention

Due to their ability to inhibit clot-bound thrombin, DTIs have also been investigated as anticoagulants for ACS and percutaneous coronary intervention (PCI). Lepirudin was examined in large numbers of patients with unstable angina or suspected acute MI without ST segment elevation in the OASIS-1 (OASIS Investigators, 1997) (n = 909) and OASIS-2 (n = 10,141) trials (OASIS Investigators, 1999). These trials concluded that lepirudin is superior to heparin in preventing ischemic outcomes. A meta-analysis of 11 ACS trials involving over 35,000 patients revealed a 15% reduction in death or MI when bivalent DTIs (lepirudin or bivalirudin) were used to treat ACS patients, compared with heparin (Direct Thrombin Inhibitors Trialists' Collaborative Group, 2002). A retrospective subset analysis of the OASIS-2 trial examined the benefit of lepirudin in 117 ACS patients undergoing PCI within the first 72 hr (Mehta et al., 2002). Lepirudin was superior to heparin in reducing the risk of death or MI at 96 hr (p = 0.036) and 35 days (p = 0.02). Based on this evidence, lepirudin should be considered a treatment option in ACS patients with HIT.

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