lepirudin

lepirudin /lep·i·ru·din/ (lep″ĭ-roo´din) a recombinant form of hirudin used as an anticoagulant in patients with heparin-induced thrombocytopenia.

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lepirudin,

a direct thrombin inhibitor.

indications It is used to treat heparin-induced thrombocytopenia and other thromboembolic conditions.

contraindication Known hypersensitivity to hirudins prohibits its use.

adverse effects Life-threatening effects of lepirudin include heart failure, pericardial effusion, ventricular fibrillation, multiorgan failure, sepsis, hematuria, hemorrhage, intracranial bleeding, and thrombocytopenia. Other adverse effects include GI bleeding, abnormal liver function tests, abnormal kidney function, pneumonia, and allergic skin reactions. Fever is a common side effect. Drug interactions with NSAIDs, aspirin, salicylates, and antiplatelets may occur. Use of the herbs feverfew, ginkgo, ginger, and valerian may potentiate bleeding. Caution should be used in its use in patients with cirrhosis of the liver.

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lepirudin Warning - High-alert drug!

Refludan

Pharmacologic class: Thrombin inhibitor

Therapeutic class: Anticoagulant

Pregnancy risk category B

Action

Binds with thrombin, blocking its thrombogenic activity

Availability

Powder for injection: 50 mg

⊘Indications and dosages

➣ Heparin-induced thrombocytopenia and associated thromboembolic disease

Adults: Initially, 0.4 mg/kg by I.V. bolus over 15 to 20 seconds (to a maximum of 44 mg), followed by 0.15 mg/kg as a continuous I.V. infusion for 2 to 10 days, or longer if needed

Dosage adjustment

• Renal impairment
• Elderly patients

Contraindications

• Hypersensitivity to drug, its components, or hirudin

Precautions

Use cautiously in:
• renal or hepatic disease, bleeding, bacterial endocarditis
• recent cerebrovascular accident or neurosurgery
• pregnant or breastfeeding patients
• children.

Administration

• Check activated partial thromboplastin time (APTT) before therapy starts.
☞ Administer I.V. bolus slowly, over at least 15 to 20 seconds.
• Follow bolus with continuous I.V. infusion for 2 to 10 days.
• To reconstitute, mix with sterile water for injection or 0.9% sodium chloride injection.
• For further dilution, use 0.9% sodium chloride injection or 5% dextrose injection.
☞ Base dosage adjustments on APTT measured 4 hours after drug initiation and then at least once daily.

Route	Onset	Peak	Duration
I.V.	Immediate	Unknown	Unknown

Adverse reactions

CNS: depression

CV: heart failure, pericardial effusion, ventricular fibrillation

GI: GI bleeding

GU: hematuria, abnormal renal function

Hematologic: hemorrhage, thrombocytopenia

Respiratory: pneumonia, hemoptysis

Skin: rash, pruritus, urticaria

Other: chills, fever, bleeding at injection site, excessive wound bleeding, multisystem failure, sepsis, anaphylaxis

Interactions

Drug-drug. Cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, nonsteroidal anti-inflammatory drugs, oral anticoagulants, platelet aggregation inhibitors, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid: increased risk of bleeding

Drug-diagnostic tests. Liver function tests: increased values

Patient monitoring

• Check vital signs frequently.
☞ Monitor APTT at least daily. Target range is 1.5 to 2.5.
• Assess fluid intake and output and monitor creatine clearance.
☞ Watch closely for signs and symptoms of bleeding.
• Monitor CBC with white cell differential; assess liver function tests.
☞ Check for adverse effects, particularly signs and symptoms of infection, multisystem failure, and cardiovascular or respiratory problems.

Patient teaching

• Explain bleeding precautions that patient should take.
☞ Teach patient to recognize and immediately report signs and symptoms of bleeding.
• Inform patient that he'll undergo frequent blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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lepirudin

Refludan^® Hematology A recombinant hirudin anticoagulant used to manage heparin-induced thrombocytopenia type II, thromboembolic disease and prevent complications in Pts with HIT Mechanism Inhibits thrombin activity. See Heparin-induced thrombocytopenia.