Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.
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.
Tardy
Bernard
B
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
Lecompte
Thomas
T
Boelhen
Françoise
F
Tardy-Poncet
Brigitte
B
Elalamy
Ismaïl
I
Morange
Pierre
P
Gruel
Yves
Y
Wolf
Martine
M
François
Dominique
D
Racadot
Evelyne
E
Camarasa
Philippe
P
Blouch
Marie Thérèse
MT
Nguyen
Françoise
F
Doubine
Sylvie
S
Dutrillaux
Fabienne
F
Alhenc-Gelas
Martine
M
Martin-Toutain
Isabelle
I
Bauters
Anne
A
Ffrench
Patrick
P
de Maistre
Emmanuel
E
Grunebaum
Lélia
L
Mouton
Christine
C
Huisse
Marie G
MG
Gouault-Heilmann
Michèle
M
Lucke
Veronique
V
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
D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin