Renal Impairment

Lepirudin has been studied in patients with varying degrees of renal impairment. It can be used safely and effectively if started at a very low dose of 0.005-0.01 mg/ kg/h, if there is evidence for renal compromise. If renal function is normal, the starting dose should be 0.05-0.10 mg/kg/h. In both situations the initial lepirudin bolus should be omitted (Table 2). In case of transient renal failure close monitoring of aPTT is mandatory. Even when renal function appears normal, the potential for unrecognized compensated renal dysfunction exists, so the initial lepirudin bolus should be avoided (unless severe thrombosis is present) and a lower infusion rate of 0.05-0.10 mg/kg/h iv started, with subsequent adjustments by aPTT.

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