RECOMBINANT HIRUDIN FOR THE TREATMENT OF DISSEMINATED INTRAVASCULAR COAGULATION IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY

The purpose of this pilot study was to determine the effect of recombi nant hirudin (r-hirudin) on coagulopathy and the relationship between concentrations of thrombin-antithrombin III (ATIII) complex (TAT) and thrombin-hirudin complex (THC) in patients with disseminated intravasc ular coagulation (DIG). Five patients with haematological malignancy a ssociated with DIC were studied. r-Hirudin was administered by continu ous intravenous infusion at a dose of 0.005 mg/kg/h for 4-9 days to ea ch patient, Fibrin/fibrinogen degradation products (FDP), D-dimer, TAT and plasmin-cu,antiplasmin complex (PAP) concentrations decreased aft er treatment with r-hirudin in four patients studied. However, in one patient, serum creatinine increased to 1.7 mg/dl and aPTT was prolonge d to 74.4 s. Statistical analysis disclosed significant positive corre lations between plasma concentrations of hirudin and THC, and between concentrations of THC and TAT. The concentrations of THC were much hig her than those of TAT. In conclusion, these findings indicate that r-h irudin more strongly inhibited thrombin than did ATIII without heparin , and that administration of r-hirudin to renal insufficiency required individual adjustment of dosage. The present findings also suggest th at r-hirudin can be considered a new agent for the treatment of DIG.