Bi. Eriksson et al., DIRECT THROMBIN INHIBITION WITH REC-HIRUDIN CGP-39393 AS PROPHYLAXIS OF THROMBOEMBOLIC COMPLICATIONS AFTER TOTAL HIP-REPLACEMENT, Thrombosis and haemostasis, 72(2), 1994, pp. 227-231
Hirudin is an anticoagulant originally extracted from the leech Hirudo
medicinalis. Using recombinant DNA technology a new compound, recombi
nant desulphato hirudin CGP 39393 has now been produced. The aim of th
is study was to determine the maximum tolerated dose in patients under
going elective hip replacement. This open safety trial represents, to
our knowledge, the first experience of recombinant hirudin in orthoped
ic patients. In this study 48 patients undergoing primary total hip re
placement were included and the safety of subcutaneous injections of 1
0, 15, 20 and 40 mg CGP 39393 twice daily, was evaluated. Prophylaxis
was started immediately pre-operatively and continued for 8-10 days. A
mandatory bilateral phlebography was performed at the end of the prop
hylactic treatment period and a clinical follow-up was done 6 weeks af
ter surgery. A major bleeding event occurred in the first 3 patients r
eceiving 40 mg CGP 39393 b.i.d. and the prophylaxis regimen at this do
sage level was therefore discontinued. Median values of total blood lo
ss and requirements of blood transfusion in the patients receiving 10-
20 mg CGP 34393 were similar to those reported in previous studies on
total hip replacement performed at the same centre, using other prophy
lactic drugs. Deep vein thrombosis (DVT) was confirmed by phlebography
in 5 out of 12 patients in the 10 mg group (41.7%, 95% confidence lim
its [CL]: 15.2-72.3%), 1 out of 11 patients in the 15 mg group (9.1%,
CL: 0.23-41.3%) and 2 out of 20 patients in the 20 mg group (10.0%, CL
: 1.2-31.7%) during the prophylaxis period. CGP 39393 was safe and wel
l tolerated, when administered as subcutaneous injections of 10-20 mg
twice daily. The dose level of 40 mg CGP 39393 twice daily resulted in
serious disturbance of the hemostasis in patients after hip prosthesi
s surgery.