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Blood, 12 March 2009, Vol. 113, No. 11, pp. 2402-2409. Prepublished online as a Blood First Edition Paper on December 4, 2008; DOI 10.1182/blood-2008-07-162271. This Article Full Text (PDF) All Versions of this Article: blood-2008-07-162271v1 113/11/2402    most recent Alert me when this article is cited Alert me if a correction is posted 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 Tschudi, M. Articles by Alberio, L. Search for Related Content PubMed PubMed Citation Articles by Tschudi, M. Articles by Alberio, L. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted July 1, 2008 Accepted December 1, 2008 Dosing lepirudin in patients with heparin-induced thrombocytopenia and normal or impaired renal function: A single-centre experience with 68 patients Martina Tschudi, Bernhard Lammle, and Lorenzo Alberio* Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland * Corresponding author; email: lorenzo.alberio{at}insel.ch. The officially recommended dose (i.v.-bolus 0.4 mg kg-1 followed by 0.15 mg kg-1 h-1) of lepirudin, a direct thrombin inhibitor licensed for treatment of heparin-induced thrombocytopenia (HIT), is too high. Starting in 2001 we omitted the bolus and reduced maintenance-dose by at least 1/3. Analysing 53 HIT-patients treated at our institution between 1.2001 and 2.2007 we observed that patients with therapeutic anticoagulation intensity already at first monitoring (4 hours after lepirudin start) had been treated with following initial lepirudin doses (median): 0.078 mg kg-1 h-1 in those with creatinine clearance (CrCl) >60 ml/min, 0.040 mg kg-1 h-1 (CrCl 30-60 ml/min), and 0.013 mg kg-1 h-1 (CrCl <30 ml/min). The efficacy of this treatment was documented by increasing platelet counts, decreasing D-dimer values and fewer thrombotic or bleeding episodes. Based on this experience we derived an in-house lepirudin dosing-regimen, which was prospectively evaluated treating 15 HIT-patients between 3.2007 and 2.2008. We show that omitting the initial lepirudin bolus dose and administering 0.08 mg kg-1 h-1 in patients with CrCl >60 ml/min, 0.04 mg kg-1 h-1 in patients with CrCl 30-60 ml/min, and 0.01-0.02 mg kg-1 h-1 in those with CrCl <30 ml/min is efficacious and safe, as documented by increasing platelet counts, decreasing D-dimer levels, and rare thrombotic (n=1/46) and major bleeding (n=4/46) complications. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: Lepirudin: Finding the Right Dose Journal Watch Oncology and Hematology, April 7, 2009; 2009(407): 3 - 3. [Full Text]

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