Lepirudin in the management of patients with heparin-induced thrombocytopenia.
Lepirudin in the management of patients with heparin-induced thrombocytopenia.
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DOI：
10.2147/btt.s3415
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发表时间：
2008-09
期刊：
影响因子：
--
通讯作者：
Petros S
中科院分区：
文献类型：
--
作者：
Petros S
Lepirudin是一种重组水蛭素，是一种直接的不可逆凝血酶抑制剂，可与游离凝血酶和凝血酶结合。它被批准用于治疗肝素诱导的血小板减少症（HIT），这是一种严重的抗体介导的药物反应，主要与未分离肝素的使用有关。近10年的临床经验证明了lepirudin治疗HIT的有效性。肾上腺素的主要清除途径是肾脏，约占其全身清除率的90%。最重要的不良反应是出血和诱导免疫反应。出血风险可以通过实施最佳监测和剂量调整策略来降低，特别是在接受体外循环手术的患者和肾功能受损的患者中。抗水蛭素抗体的产生可增强lepirudin的抗凝血作用。与麻黄素治疗相关的过敏反应是罕见的。缺乏对lepirudin的解毒剂仍然是一个问题，特别是在心肺机体外循环手术和人工肾支持期间。目前，使用高通量过滤系统的血液过滤是管理水蛭素过量的唯一可用和有效的手段。然而，如果安装严密的监测策略，该药物可以安全使用。
Lepirudin, a recombinant hirudin, is a direct irreversible thrombin inhibitor by binding to both free and clot-bound thrombin. It is approved for treatment of heparin-induced thrombocytopenia (HIT), which is a serious antibody-mediated drug reaction mostly associated with the use of unfractionated heparin. Clinical experience during the last 10 years has proved the efficacy of lepirudin in the management of HIT. The major route of elimination of lepirudin is the kidney, accounting for approximately 90% of its systemic clearance. The most important adverse reactions are bleeding and the induction of immunologic reactions. The risk of bleeding can be reduced by implementing an optimal monitoring and dose adjustment strategy, particularly in patients undergoing cardiopulmonary bypass surgery and in those with impaired renal function. Development of antihirudin antibodies may enhance the anticoagulant effect of lepirudin. Anaphylactic reactions associated with lepirudin therapy are rare. The lack of an antidote against lepirudin is still a concern, particularly during cardiopulmonary bypass surgery with a heart-lung machine and during artificial renal support. Currently, hemofiltration using high-flux filter systems is the only available and valid means to manage hirudin overdose. Nevertheless, the drug can be safely used if meticulous monitoring strategy is installed.