title: Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.
abstract: The antithrombotic efficacy of lepirudin in patients with heparin-induced thrombocytopenia (HIT) is compromised by an increased risk for bleeding. A retrospective observational analysis in 181 patients (median age, 67 years) with confirmed HIT treated in routine practice with lepirudin was performed to identify predictive factors for thrombotic and bleeding complications. Lepirudin was administered at a mean (+/- SD) dose of 0.06 +/- 0.04 mg/kg/h (compared with a recommended initial dose of 0.15 mg/kg/h). Mean activated partial thromboplastin time was greater than 1.5 times baseline value in 99.4% of patients. Median treatment duration was 7.7 days. Until discharge from the hospital, 13.8% and 20.4% of patients experienced a thrombotic or a major bleeding event, respectively. On multivariate analysis, mean lepirudin dose was not a significant predictive factor for thrombosis. In contrast, mean lepirudin dose greater than 0.07 mg/kg/h, long duration of lepirudin treatment, and moderate to severe renal impairment were significant positive factors for major bleeding. Overall, these results suggest that the recommended dose of lepirudin in patients with HIT is too high; the use of reduced doses may be safer with regard to bleeding risk and does not compromise antithrombotic efficacy.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (Inserm) Centre d'Investigation Clinique Epidémiologique 3 (CIC E3), Service d'Urgence et de Réanimation Médicales Hôpital Bellevue, Saint-Etienne, France. bernardtardy@yahoo.fr
authors.forename: Bernard
authors.initials: B
authors.lastname: Tardy
authors.forename: Thomas
authors.initials: T
authors.lastname: Lecompte
authors.forename: Françoise
authors.initials: F
authors.lastname: Boelhen
authors.forename: Brigitte
authors.initials: B
authors.lastname: Tardy-Poncet
authors.forename: Ismaïl
authors.initials: I
authors.lastname: Elalamy
authors.forename: Pierre
authors.initials: P
authors.lastname: Morange
authors.forename: Yves
authors.initials: Y
authors.lastname: Gruel
authors.forename: Martine
authors.initials: M
authors.lastname: Wolf
authors.forename: Dominique
authors.initials: D
authors.lastname: François
authors.forename: Evelyne
authors.initials: E
authors.lastname: Racadot
authors.forename: Philippe
authors.initials: P
authors.lastname: Camarasa
authors.forename: Marie Thérèse
authors.initials: MT
authors.lastname: Blouch
authors.forename: Françoise
authors.initials: F
authors.lastname: Nguyen
authors.forename: Sylvie
authors.initials: S
authors.lastname: Doubine
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dutrillaux
authors.forename: Martine
authors.initials: M
authors.lastname: Alhenc-Gelas
authors.forename: Isabelle
authors.initials: I
authors.lastname: Martin-Toutain
authors.forename: Anne
authors.initials: A
authors.lastname: Bauters
authors.forename: Patrick
authors.initials: P
authors.lastname: Ffrench
authors.forename: Emmanuel
authors.initials: E
authors.lastname: de Maistre
authors.forename: Lélia
authors.initials: L
authors.lastname: Grunebaum
authors.forename: Christine
authors.initials: C
authors.lastname: Mouton
authors.forename: Marie G
authors.initials: MG
authors.lastname: Huisse
authors.forename: Michèle
authors.initials: M
authors.lastname: Gouault-Heilmann
authors.forename: Veronique
authors.initials: V
authors.lastname: Lucke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006470:Hemorrhage; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin