title: Lepirudin for anticoagulation in patients with heparin-induced thrombocytopenia treated with continuous renal replacement therapy.
abstract: Lepirudin is a potent, direct thrombin inhibitor used for anticoagulation in patients with heparin-induced thrombocytopenia type II (HIT). The half-life of lepirudin is prolonged in patients with renal insufficiency. Preliminary studies suggest that it is safe to use lepirudin in patients being treated with intermittent hemodialysis but information regarding its use with continuous renal replacement therapy (CRRT) is scarce. CRRT is used in acute care settings to remove fluid and uremic toxins in patients with renal failure with hemodynamic instability. Patients with HIT, renal failure, and hemodynamic instability pose a complex situation for clinical management. These patients require anticoagulation with nonheparin agents with simultaneous CRRT. There are no guidelines in the literature regarding the management of this patient group. We report our experience with lepirudin at managing four such patients with HIT, being treated with CRRT.
authors.affiliation: Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York, USA. ajeet.gajra@med.va.gov
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.forename: Neerja
authors.initials: N
authors.lastname: Vajpayee
authors.forename: Arienne
authors.initials: A
authors.lastname: Smith
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Poiesz
authors.forename: Sriram
authors.initials: S
authors.lastname: Narsipur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D006207:Half-Life; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology; D011183:Postoperative Complications; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin