The antithrombotic efficacy of
lepirudin in patients with
heparin-induced
thrombocytopenia (HIT) is compromised by an increased risk for
bleeding. A retrospective observational analysis in 181 patients (median age, 67 years) with confirmed HIT treated in routine practice with
lepirudin was performed to identify predictive factors for thrombotic and
bleeding complications.
Lepirudin was administered at a mean (+/- SD) dose of 0.06 +/- 0.04 mg/kg/h (compared with a recommended initial dose of 0.15 mg/kg/h). Mean activated partial thromboplastin time was greater than 1.5 times baseline value in 99.4% of patients. Median
treatment duration was 7.7 days. Until discharge from the hospital, 13.8% and 20.4% of patients experienced a thrombotic or a major
bleeding event, respectively. On multivariate analysis, mean
lepirudin dose was not a significant predictive factor for
thrombosis. In contrast, mean
lepirudin dose greater than 0.07 mg/kg/h, long duration of
lepirudin treatment, and moderate to severe renal impairment were significant positive factors for major
bleeding. Overall, these results suggest that the recommended dose of
lepirudin in patients with HIT is too high; the use of reduced doses may be safer with regard to
bleeding risk and does not compromise antithrombotic efficacy.