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Blood, 1 September 2006, Vol. 108, No. 5, pp. 1492-1496. Prepublished online as a Blood First Edition Paper on May 11, 2006; DOI 10.1182/blood-2006-02-001057. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2006-02-001057v1 108/5/1492    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tardy, B. Articles by Lucke, V. Search for Related Content PubMed PubMed Citation Articles by Tardy, B. Articles by Lucke, V. Related Collections Hemostasis, Thrombosis, and Vascular Biology Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin Bernard Tardy, Thomas Lecompte, Françoise Boelhen, Brigitte Tardy-Poncet, Ismaïl Elalamy, Pierre Morange, Yves Gruel, Martine Wolf, Dominique François, Evelyne Racadot, Philippe Camarasa, Marie Thérèse Blouch, Françoise Nguyen, Sylvie Doubine, Fabienne Dutrillaux, Martine Alhenc-Gelas, Isabelle Martin-Toutain, Anne Bauters, Patrick Ffrench, Emmanuel de Maistre, Lélia Grunebaum, Christine Mouton, Marie G. Huisse, Michèle Gouault-Heilmann, Veronique Lucke, for the GEHT-HIT study group From the 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. 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. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Lepirudin: walking the dosing line Gowthami M. Arepally and Theodore E. Warkentin Blood 2006 108: 1428-1429. [Full Text] [PDF] This article has been cited by other articles: M. Tschudi, B. Lammle, and L. Alberio Dosing lepirudin in patients with heparin-induced thrombocytopenia and normal or impaired renal function: a single-center experience with 68 patients Blood, March 12, 2009; 113(11): 2402 - 2409. [Abstract] [Full Text] [PDF] S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [Abstract] [Full Text] [PDF] T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 340S - 380S. [Abstract] [Full Text] [PDF] M. A. Crowther and T. E. Warkentin Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents Blood, May 15, 2008; 111(10): 4871 - 4879. [Abstract] [Full Text] [PDF] S. Yoshida, T. Sudo, M. Niimi, L. Tao, B. Sun, J. Kambayashi, H. Watanabe, E. Luo, and H. Matsuoka Inhibition of collagen-induced platelet aggregation by anopheline antiplatelet protein, a saliva protein from a malaria vector mosquito Blood, February 15, 2008; 111(4): 2007 - 2014. [Abstract] [Full Text] [PDF] B. L. Lobo Use of newer anticoagulants in patients with chronic kidney disease Am. J. Health Syst. Pharm., October 1, 2007; 64(19): 2017 - 2026. [Abstract] [Full Text] [PDF] J. H. Levy, K. A. Tanaka, and M. J. Hursting Reducing Thrombotic Complications in the Perioperative Setting: An Update on Heparin-Induced Thrombocytopenia Anesth. Analg., September 1, 2007; 105(3): 570 - 582. [Abstract] [Full Text] [PDF] Lepirudin Treatment of Heparin-Induced Thrombocytopenia Journal Watch Oncology and Hematology, October 11, 2006; 2006(1011): 3 - 3. [Full Text] T. E. Warkentin Think of HIT Hematology, January 1, 2006; 2006(1): 408 - 414. [Abstract] [Full Text] [PDF]

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