DALI LDL-apheresis: anticoagulation with r-hirudin in a patient with heparin-induced thrombocytopenia (HIT II).
A 50-year old male patient with familial hypercholesterolemia and hyperlipoproteinemia (a), who underwent low density lipoprotein-apheresis treatment developed heparin-induced thrombocytopenia type II (HIT II). Because heparin is contraindicated in patients with HIT, an alternative LDL-apheresis system and modified anticoagulation regimen was necessary. Treatment was changed to a new system called DALI (direct adsorption of lipids). After confirmation of the diagnosis HIT II, DALI LDL-apheresis was carried out with recombinant-hirudin (lepirudin) and citrate in order to prevent hypercoagulability. Efficient LDL-apheresis therapy with minimum therapeutic blood levels of lepirudin (1.4 mg/dl) was achieved with an initial intravenous bolus of 0.114 mg/kg of lepirudin followed by continuous lepirudin infusion of 0.350 mg/h. Thrombin-antithrombin III complex production was well controlled and other hemostatic markers showed no abnormalities. LDL-cholesterol and lipoprotein(a) concentrations were effectively reduced. R-hirudin offers a novel anticoagulation strategy and is, at present, the only alternative for patients with HIT II requiring LDL-apheresis on a regular basis.
Thomas
H P
HP
Charité Medical Faculty of Humboldt University of Berlin, Virchow -Clinic, Medizinische Poliklinik, LDL-Apherese, Germany. hans-peter.thomas@charite.de
Kassner
U
U
Schliesser
C
C
Steinhagen-Thiessen
E
E
D000991:Antithrombins / Q000008:administration & dosage*; D001781:Blood Component Removal / Q000379:methods*; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000628:therapy*; D006951:Hyperlipoproteinemias / Q000628:therapy*; D007275:Injections, Intravenous; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications
D000991:Antithrombins; D006629:Hirudins; D008077:Lipoproteins, LDL; D011994:Recombinant Proteins; D006493:Heparin