Rapid anticoagulation using ancrod for heparin-induced thrombocytopenia.
In order to determine the efficacy and safety of ancrod, a rapid acting defibrinogenating drug, for patients with heparin-induced thrombocytopenia, 11 consecutive patients who required anticoagulant therapy because of venous thromboembolism and who developed acute heparin-induced thrombocytopenia or had a history of heparin-induced thrombocytopenia were treated with ancrod. Heparin therapy was discontinued (in patients receiving heparin) and ancrod started at a dose of 1 to 2 U/kg every 24 hours with subsequent daily doses adjusted to maintain fibrinogen levels between 0.5 and 1.0 g/L. Ancrod was continued until warfarin had become effective. The platelet count increased to more than 150 x 10(9)/L within 2 to 10 days in all thrombocytopenic patients. Two patients with a history of heparin-induced thrombocytopenia maintained normal platelet counts while receiving ancrod. Two patients had recurrent venous thrombosis while receiving warfarin, 10 days after ancrod was discontinued: one of these patients had metastatic pancreatic carcinoma and developed phlegmasia cerulea dolens and the other patient developed a venographically proven extension of her deep venous thrombosis. One patient suffered a bleeding episode into the thigh with a 16-g/L decrease in her hemoglobin level while receiving ancrod therapy. No other side effects were noted. Our experience indicates that ancrod therapy is a reasonable approach for patients with heparin-induced thrombocytopenia who require anticoagulant therapy.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
C
C
Demers
J S
JS
Ginsberg
P
P
Brill-Edwards
A
A
Panju
T E
TE
Warkentin
D R
DR
Anderson
C
C
Turner
J G
JG
Kelton
D000368:Aged; D000369:Aged, 80 and over; D000721:Ancrod / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced*; D013924:Thrombophlebitis / Q000188:drug therapy*
D000925:Anticoagulants; D006493:Heparin; D000721:Ancrod