title: Management of heparin-associated thrombocytopenia in pregnancy with subcutaneous r-hirudin.
abstract: Heparin-induced thrombocytopenia type II is a serious, immune-mediated complication of heparin therapy. Due to its low cross-reactivity with heparin-associated antibodies (10-20%), danaparoid has successfully been administered in these patients. In recent studies, r-hirudin as a potent and specific thrombin inhibitor, was demonstrated to be a safe and effective anticoagulant. We report a pregnant woman with systemic lupus erythematosus and recurrent venous thromboembolism who suffered from heparin-induced thrombocytopenia type II while treated with dalteparin sodium. Positive cross-reactivities with danaparoid were found. Anticoagulation with 15 mg subcutaneous r-hirudin was performed twice daily from the 25th week of pregnancy until delivery. No thromboembolism or bleeding or fetal toxicity of r-hirudin was detected. Recombinant hirudin is a potent and specific thrombin inhibitor that can be used as a safe and effective anticoagulant in pregnancy.
authors.affiliation: 1st Department of Medicine, Faculty of Clinical Medicine Mannheim, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Huhle
authors.forename: M
authors.initials: M
authors.lastname: Geberth
authors.forename: U
authors.initials: U
authors.lastname: Hoffmann
authors.forename: D L
authors.initials: DL
authors.lastname: Heene
authors.forename: J
authors.initials: J
authors.lastname: Harenberg
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects; D000991:Antithrombins / Q000627:therapeutic use*; D017985:Dalteparin / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy* / Q000276:immunology; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D011994:Recombinant Proteins; D006493:Heparin; D017985:Dalteparin