The direct thrombin inhibitor hirudin.
This review discusses the pharmacology and clinical applications of hirudin, a bivalent direct thrombin inhibitor (DTI). Besides the current major indication for hirudin--anticoagulation of patients with heparin-induced thrombocytopenia (HIT)--the experience with hirudin in other indications, especially acute coronary syndromes, are briefly presented. Hirudins have been formally studied prior to their regulatory approval; however, important information on their side effects and relevant preventative measures only became available later. Therefore, current recommendations and dosing schedules for hirudin differ considerably from the information given in the package inserts. Drawbacks of hirudin and important precautions for avoiding potential adverse effects are discussed in detail in the third part of this review.
Greinacher
Andreas
A
Institute for Immunology and Transfusion Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstrasse, 17489 Greifswald, Germany. greinach@uni-greifswald.de
Warkentin
Theodore E
TE
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass; D016903:Drug Monitoring; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006488:Hemostasis, Surgical / Q000379:methods; D006493:Heparin / Q000009:adverse effects; D024764:Hirudin Therapy; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000493:pharmacokinetics; D006801:Humans; D011516:Prothrombin / Q000378:metabolism; D006435:Renal Dialysis; D013917:Thrombin / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D014656:Vascular Surgical Procedures
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006629:Hirudins; D011516:Prothrombin; D006493:Heparin; D013917:Thrombin