Clinico-pharmacological studies with recombinant hirudin

Markwardt, Fritz; Nowak, G; Stürzebecher, Jörg; Vogel, Günther

doi:10.1016/0049-3848(88)90023-0

Cited by 103 publications

(109 citation statements)

References 8 publications

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“…77,78 Although small numbers of case reports have documented successful outcomes with r-hirudin use in pregnancy, 77,79,80 there are insuffi cient data to evaluate its safety. Three case reports have been published describing the use of argatroban late in pregnancy.…”

Section: Parenteral Direct Thrombin Inhibitor Exposure In Uteromentioning

confidence: 99%

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

Bates

Greer

Middeldorp

et al. 2012

Chest

1,307

591

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Summary of RecommendationsNote on Shaded Text: Throughout this guideline, shading is used within the summary of recommendations sections to indicate recommendations that are newly added or have been changed since the publication of Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Recommendations that remain unchanged are not shaded. Abbreviations: APLA 5 antiphospholipid antibody; aPPT 5 activated partial thromboplastin time; HIT 5 heparin-induced thrombocytopenia; INR 5 international normalized ratio; LMWH 5 low-molecular-weight heparin; NNT 5 number needed to treat; PE 5 pulmonary embolism; RR 5 risk ratio; UFH 5 unfractionated heparin

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Section: Parenteral Direct Thrombin Inhibitor Exposure In Uteromentioning

confidence: 99%

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

Bates

Greer

Middeldorp

et al. 2012

Chest

1,307

591

View full text Add to dashboard Cite

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“…It has proved efficacious in preventing and treating both venous and arterial thrombi. Its pharmacokinetics reveal very low transfer through the placenta and fetal integument [4]. Hence it is a logical choice for use in heparin-allergic patients in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Management of heparin allergy in pregnancy

2001

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Thromboembolic disease during pregnancy has traditionally been treated with heparin. If heparin cannot be used, then treatment options remain limited. Despite the recent availability of new anticoagulation agents, data relating to their use during pregnancy is lacking. Hirudin, a relatively new anti-thrombotic agent, through animal models has been shown to have a very low transplacental transfer, thus making it a candidate drug to be used during pregnancy in case of heparin allergy. This report describes a case of heparin allergy in a pregnant patient with recurrent DVT that was successfully managed with hirudin and coumadin. Am. J. Hematol. 67:268-269, 2001.

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“…Danaparoid and fondaparinux 57 do not appear to cross the placenta, whereas DTIs can cross the placenta in low doses 58 and have caused embryopathy in rabbits given high doses of hirudin. 59 Furthermore, a zebrafish model reveals thrombin to play a role in embryogenesis.…”

Section: Special Topicsmentioning

confidence: 99%

Platelet-Endothelial Interactions: Sepsis, HIT, and Antiphospholipid Syndrome

Warkentin

Aird²,

Rand³

2003

Hematology

144

108

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Acquired abnormalities in platelets, endothelium, and their interaction occur in sepsis, immune heparin-induced thrombocytopenia (HIT), and the antiphospholipid syndrome. Although of distinct pathogeneses, these three disorders have several clinical features in common, including thrombocytopenia and the potential for life-and limb-threatening thrombotic events, ranging from microvascular (sepsis > antiphospholipid > HIT) to macrovascular (HIT > antiphospholipid > sepsis) thrombosis, both venous and arterial.In Section I, Dr. William Aird reviews basic aspects of endothelial-platelet interactions as a springboard to considering the common problem of thrombocytopenia (and its mechanism) in sepsis. The relationship between thrombocytopenia and other aspects of the host response in sepsis, including activation of coagulation/inflammation pathways and the development of organ dysfunction, is discussed. Practical issues of platelet count triggers and targeted use of activated protein C concentrates are reviewed.In Section II, Dr. Theodore Warkentin describes HIT as a clinicopathologic syndrome, i.e., the diagnosis should be based on the concurrence of an appropriate clinical picture together with detection of platelet-activating and/or platelet factor 4-dependent antibodies (usually in high levels). HIT is a profound prothrombotic state (odds ratio for thrombosis, 20-40), and the risk for thrombosis persists for a time even when heparin is stopped. Thus, pharmacologic control of thrombin (or its generation), and postponing oral anticoagulation pending substantial resolution of thrombocytopenia, is appropriate. Indeed, coumarin-associated protein C depletion during uncontrolled thrombin generation of HIT can explain limb loss (coumarin-associated venous limb gangrene) or skin necrosis syndromes in some patients.In Section III, Dr. Jacob Rand presents the most recent concepts on the mechanisms of thrombosis in the antiphospholipid syndrome, and focuses on the role of β β β β β 2 -glycoprotein I as a major antigenic target in this condition. Diagnosis of the syndrome is often complicated because the clinical laboratory tests to identify this condition have been empirically derived. Dr. Rand addresses the practical aspects of current testing for the syndrome and current recommendations for treating patients with thrombosis and with spontaneous pregnancy losses. I. ENDOTHELIAL-PLATELET INTERPLAY IN SEPSIS William C. Aird, MD*This section will review the role of platelet-endothelial cell interactions in sepsis. The goals are to: 1) underscore the importance of platelet-endothelial cell dialogue in both health and disease, 2) consider thrombocytopenia in the context of the overall host response to sepsis, 3) highlight the potential for co-existence of thrombocytopenia and a hypercoagulable state, and 4) argue that optimal treatment for thrombocytopenia in sepsis is to target the underlying host response, and not the platelets per se. Platelet-Endothelial Cell InteractionsMost hematologists are intimately familiar with the ci...

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Clinico-pharmacological studies with recombinant hirudin

Cited by 103 publications

References 8 publications

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

Management of heparin allergy in pregnancy

Platelet-Endothelial Interactions: Sepsis, HIT, and Antiphospholipid Syndrome

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