title: Lepirudin in the management of heparin-induced thrombocytopenia.
abstract: BACKGROUND
  Lepirudin is a recombinant hirudin that exerts its anticoagulant effect by direct inhibition of thrombin. Lepirudin is indicated for anticoagulation in patients with heparin-induced thrombocytopenia (HIT) and associated thromboembolic disease to prevent further thromboembolic complications.
  
  
  OBJECTIVE
  This review addresses various clinical uses of lepirudin including but not limited to FDA approved indication. The objective is to provide an updated overview of the clinical use and pharmacology of the agent. In addition, we address certain areas of controversy especially pertaining to dosing of lepirudin and its use in different clinical situations.
  
  
  METHODS
  Literature was reviewed using appropriate search terms in Pubmed and Ovid medline databases.
  
  
  CONCLUSIONS
  Lepirudin continues to be a valuable anticoagulant in the management of HIT. Lepirudin has the highest recommendation in treatment of HIT based on evidence from clinical trials. Minor modifications in dosing over the standard label recommendations may simplify its use and enhance safety.
authors.affiliation: SUNY Upstate Medical University, Department of Medicine, 750 E Adams Street, CWB # 275, Syracuse, NY 13210, USA. GajraA@upstate.edu
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.forename: Juhi
authors.initials: J
authors.lastname: Husain
authors.forename: Adrienne
authors.initials: A
authors.lastname: Smith
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin