Lepirudin: A substitute for heparin in patients with heparin-induced thrombocytopenia

Lepirudin, a recombinant hirudin, is a parenteral anticoagulant that could potentially be used as an alternative to heparin in a number of thrombotic disorders, including deep vein thrombosis and unstable angina. Of particular importance, lepirudin could have a role as a substitute anticoagulant for patients who develop heparin-induced thrombocytopenia (HIT). Although some patients develop antibodies to lepirudin, these antibodies do not cross-react with heparin-induced antibodies and the drug does not cause immune-mediated thrombocytopenia. Approximately two-thirds of patients with HIT who were treated with lepirudin in clinical trials had adequate anticoagulation and normalisation of platelet counts. As with other anticoagulants, bleeding complications are of concern with the use of lepirudin. Extreme caution is required if lepirudin is to be used in combination with thrombolytics. Allergic reactions to lepirudin can occur.