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Prepublished online as a Blood First Edition Paper on October 17, 2002; DOI 10.1182/blood-2002-04-1055.
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Blood, 1 April 2003, Vol. 101, No. 7, pp. 2617-2619
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Antihirudin antibodies following low-dose subcutaneous
treatment with desirudin for thrombosis prophylaxis after
hip-replacement surgery: incidence and clinical relevance
Andreas Greinacher,
Petra Eichler,
Dorothea Albrecht,
Ulrike Strobel,
Bernd Pötzsch, and
Bengt I. Eriksson
From the Institute for Immunology and Transfusion
Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald,
Germany; the Institute for Experimental Haematology and
Transfusion Medicine, University Bonn, Bonn, Germany; and the
Department of Orthopedic Surgery, Sahlgrenska University
Hospital/ÖSTRA, Göteborg University,
Sweden.
Recombinant hirudin has been found to be immunogenic in patients
treated with lepirudin following heparin-induced
thrombocytopenia (HIT). We assessed the incidence of
immunoglobulin G (IgG) antihirudin antibodies by
enzyme-linked immunosorbent assay in 112 patients enrolled in a
dose-finding study with desirudin. Patients received desirudin
subcutaneously following orthopedic hip surgery at 10 mg twice
a day (n = 17), 15 mg twice a day (n = 75), and 20 mg twice a day
(n = 20). Of 112 patients, 11 (9.8%) developed antihirudin antibodies independently of the dose. The rate of immunization did not
differ from that observed in HIT patients treated with lepirudin
(P = .113). Plasma concentrations of desirudin did not differ between antihirudin antibody-positive and -negative patients. Antihirudin antibodies had no impact on incidences of deep vein thrombosis and/or pulmonary embolism, allergic reactions, and hemorrhage. However, the total number of immunized patients observed was low and so infrequent (but severe) effects of antihirudin antibodies cannot be excluded.
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