Lepirudin anticoagulation for heparin-induced thrombocytopenia

Deitcher, Steven R.; Topoulos, Arthur P.; Bartholomew, John R.; Kichuk-Chrisant, Maryanne R.

doi:10.1067/mpd.2002.121384

Cited by 64 publications

(52 citation statements)

References 9 publications

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“…In renal dysfunction, the half-life of lepirudin and bivalirudin may be extended to days, 16 placing patients at risk of coagulopathic complications. 17 Both aPTT and ACT may be used to monitor anticoagulation while on ECLS. At our institution, anticoagulation for patients on ECLS is adjusted based on ACT determinations due to its rapid availability.…”

Section: Discussionmentioning

confidence: 99%

A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

Cornell¹,

Wyrick²,

Fleming³

et al. 2007

ASAIO Journal

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Anticoagulation for extracorporeal life support (ECLS) is routinely achieved using heparin, which can be difficult in patients suspected of having heparin-induced thrombocytopenia. We describe a case series of five patients in which we used argatroban, a direct thrombin inhibitor, as an alternative to heparin for systemic anticoagulation during ECLS in patients suspected to have heparin-induced thrombocytopenia. Argatroban was used to achieve target systemic anticoagulation for activate clotting times between 210 and 230. Duration of argatroban use while on ECLS ranged from 6 to 184 hours. Argatroban dosage ranged from 0.2 to 3.5 microg/kg/min. Activated clotting times showed good agreement with aPTT. In conclusion, we illustrate that argatroban is a reasonable alternative to heparin anticoagulation for patients requiring ECLS.

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Section: Discussionmentioning

confidence: 99%

A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

Cornell¹,

Wyrick²,

Fleming³

et al. 2007

ASAIO Journal

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“…Danaparoid, lepirudin and argatroban have been used in children but until recently published studies have been limited to case reports (Saxon et al, 1999;Deitcher et al, 2002).…”

Section: Heparin Induced Thrombocytopenia (Hit)mentioning

confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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“…It is well established that DTIs manifest more predictable effects as anticoagulants in comparison with heparin, as they are not readily neutralized by platelet factor 4 (PF4) and they do not bind to plasma proteins [8]. Properties of DTIs used to date in the paediatric population are summarized in Table 1 ( [5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]). …”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 98%

“…Seven of eight patients were suspected for or were diagnosed with HIT, with the remaining patient being treated for thrombotic complications stemming from congenital afibrogenaemia [17][18][19][20]32]. Of the four patients requiring resolution of thromboses, boluses ranging from 0.2-0.4 mg/kg were given to three patients [17,18,20].…”

Section: Lepirudinmentioning

confidence: 99%

Novel paediatric anticoagulants: a review of the current literature

Chan

Monagle

Massicotte

et al. 2010

Blood Coagulation &Amp; Fibrinolysis

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There are many limitations with respect to anticoagulants currently used in standard paediatric practice for prophylaxis and treatment of thrombosis: heparin, low molecular-weight heparin, and warfarin. Factors such as pharmacokinetic and dosing variability are further exacerbated by properties of the immature haemostatic system of children. These shortcomings necessitate exploring alternative anticoagulants in the paediatric population. In this review, we discuss several promising direct thrombin inhibitors and factor Xa inhibitors, and synthesize relevant drug information and clinical experience from the limited available case reports, case series, and nonrandomized dose-finding trials published to date.

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Lepirudin anticoagulation for heparin-induced thrombocytopenia

Cited by 64 publications

References 9 publications

A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

Aspects of anticoagulation in children

Novel paediatric anticoagulants: a review of the current literature

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