Heparin-induced thrombocytopenia - Recommendations for optimal use of recombinant hirudin

Recombinant hirudins have a definite role in the treatment of patients with heparin-induced thrombocytopenia (HIT), The most important adverse effects are haemorrhages and the induction of antihirudin antibodies, Major haemor rhages were not significantly increased in patients with HIT compared with a historical control group, but prospective data comparing hirudin and hepa rinoids such as danaparoid are lacking, The definition of the optimal metho d for monitoring and the availability an antidote for hirudin would probabl y increase safety with this drug. To date, haemofiltration using high-flux filter systems is the only way to remove an overdosage of hirudin from the circulation. In patients with renal impairment requiring hirudin treatment, it therefore seems safer to start with a low dose that is subsequently adj usted according to the activated partial prothromboplastin time or ecarin c lotting time. Even in special circumstances, such as cardiopulmonary bypass or dialysis, hirudins can be applied successfully if care is taken to monitor their effe cts meticulously. There an many other indications in which hirudins have shown feasibility (e .g. acute coronary syndromes) but available data preclude definite conclusi ons.