Lepirudin as a safe alternative for effective anticoagulation in patients with known heparin‐induced thrombocytopenia undergoing percutaneous coronary intervention: Case reports

Abstract

Heparin-induced thrombocytopenia (HIT) is a well-documented complication of heparin anticoagulation therapy. Heparin's frequent use in the cardiovascular population poses a significant challenge for managing patients with HIT in need of percutaneous coronary intervention (PCI). We describe four patients with HIT who successfully underwent PCI without thrombotic or hemorrhagic complications while on lepirudin.

When Heparins Promote Thrombosis

“…91,103 In the largest retrospective series, 91 9 patients with a history of HIT or current HIT underwent 10 interventional procedures with lepirudin anticoagulation and glycoprotein IIb/IIIa blockade. Drug doses were not reported.…”

How I treat heparin-induced thrombocytopenia and thrombosis

“…37 Lepirudin has also been used successfully in patients with HIT requiring percutaneous coronary intervention. 38 Doses sufficient to maintain the activated clotting time between 200 and 400 seconds have been used.…”

From confusion to clarity: Direct thrombin inhibitors for patients with heparin‐induced thrombocytopenia

“…Extensive experience has been obtained with these direct thrombin inhibitors in PCI, particularly with hirudin and bivalirudin. It is reassuring to have the clarity of vision from several large clinical trials evaluating direct thrombin inhibitors, as well as the selective experience of Manfredi and coworkers [2], to provide a choice of anticoagulants during PCI.…”

“…Until the recent approval of direct thrombin inhibitors, the management of patients with HIT was confusing. In this issue of Catheterization and Cardiovascular Interventions, Manfredi and coworkers [2] describe four patients with HIT who successfully underwent percutaneous coronary interventions (PCI) with lepirudin, a direct thrombin inhibitor. The cases exemplify the ease with which direct thrombin inhibitors can substitute for heparin during PCI and emphasize the importance of selecting an appropriate alternative anticoagulant in patients with HIT.…”