Re-exposure to recombinant (r)-hirudin in antihirudin antibody-positive patients with a history of heparin-induced thrombocytopenia.
Patients with a history of heparin-induced thrombocytopenia (HIT) and antibodies to hirudin were re-exposed to recombinant (r)-hirudin for prophylaxis of thromboembolism. Four patients were re-exposed to 2 x 25 mg of subcutaneous r-hirudin for 8-27 d. Two patients were re-exposed once, one patient twice and one four times. Re-exposure was well tolerated in all patients and no thromboembolism occurred. Antihirudin IgG (4/4 patients), IgA and IgM (1/4 patients) antibody levels increased. Baseline ecarin clotting times showed high variability. Patients with antibodies to hirudin may be re-exposed but anticoagulant monitoring is mandatory.
Harenberg
J
J
Department of Medicine I, University Hospital, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University of Heidelberg, Mannheim, Germany. J-Harenberg@t-online.de
Huhle
G
G
Wang
L C
LC
Hoffmann
U
U
Song
X H
XH
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy; D006629:Hirudins / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology; D013923:Thromboembolism / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D014914:Whole Blood Coagulation Time
D000906:Antibodies; D000925:Anticoagulants; D006629:Hirudins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D011994:Recombinant Proteins; D006493:Heparin; C060225:desirudin