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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.
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Submitted February 1, 2006
Accepted April 20, 2006
Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin
Bernard Tardy*
INSERM CIC E3, University Hospital Saint-Etienne
* Corresponding author; email: bernardtardy{at}yahoo.fr.
The antithrombotic efficacy of lepirudin in patients with heparin-induced thrombocytopenia (HIT) is compromised by an increased bleeding risk. We performed a retrospective observational analysis in 181 patients (median age: 67 years) with confirmed HIT treated in routine practice with lepirudin, to identify predictive factors for thrombotic and bleeding complications. Lepirudin was administered at a mean (± standard deviation) dose of 0.06 ± 0.04 mg/kg per hour (compared with a recommended initial dose of 0.15 mg/kg per hour). The mean activated partial thromboplastin time was above 1.5 times baseline value in 99.4% of patients. The median treatment duration was 7.7 days. During lepirudin treatment, 13.8% and 20.4% of patients developed 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 above 0.07 mg/kg per hour, as well as 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 HIT patients is too high; the use of reduced doses may be safer in terms of bleeding risk without compromising antithrombotic efficacy.
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