If HIT is suspected or confirmed, a direct thrombin inhibitor, such as argatroban or lepirudin
, should be considered .
Direct thrombin inhibitors (DTIs), such as argatroban, dabigatran, lepirudin
, desirudin, and bivalirudin, which bind to thrombin and block its enzymatic activity, are widely and effectively used in the treatment of thromboembolic diseases; however, dabigatran is not orally available due to its high polarity .
Antibodies against lepirudin
are polyspecific and recognize epitopes on bivalirudin.
Treatment is aimed at stopping all sources of heparin and starting the patient on nonheparin therapeutic anticoagulants such as argatroban, lepirudin
, or danaparoid, given that these patients are in a prothrombotic state .
Activation of antithrombin-III is the one the mechanisms and anticoagulant drugs like Lepirudin
, Dalteparin, and Fondaparinux are the other [58, 59].
Looser clot structure has also been shown in the presence of argatroban, bivalirudin, lepirudin
, and danaparoid .
The Pediatric Health Information System database was queried for pediatric patients discharged from January 1, 2004 to December 31, 2011 if they received one of the following DUs during admission: argatroban, bivalirudin, desirudin, or lepirudin
. Patients were excluded if they were 19 years of age or older or had missing data.
 The first novel anticoagulant (NOAC) and direct thrombin inhibitor (DTI), lepirudin
, originates from 1998, when its intravenous form was approved for the use of clinically relevant heparin-induced thrombocytopenia (HIT).
Nuevas moleculas actualmente en fases de experimentacion clinica son los inhibidores selectivos de la trombina de administracion parenteral (desirudin, lepirudin
, bivalirudin, argatroban) y oral (ximelagatran y dabigatran etexilate) y los inhibidores orales del factor Xa (rivaroxaban, razaxaban y apixaban) [2,48].
Sanofi ([double dagger]) Clexhane/enoxaparin Injection ILA01 34751 OLC56 ILA53 OLC07 12255 Pfizer ([section]) Fragmin/dalteparin Injection sodium 12339A01 12338A01 12327B01 12257A01 12444A01 12122C01 74774D51 74871B51 74779G51 74871B51 74743C52 74755A51 74832A52 74832A01 X08580 ([paragraph]) Wockhart (#) Monoparin Injection PK40319 3090 Hepsal Flushing 5000090 91180 1069 Leo ** Heparin Intravenous sodium flushing DD7314 CC4338 Ceigene ([dagger])([dagger]) Refludan/ Powder used for Lepirudin
, solution for 25561611A ([double dagger]) injection/infusion ([double dagger]) Total quantity tested NA Producer, Excipient proprietary name/other names, batch or lot no.
Native hirudin and recombinant hirudins (lepirudin
and desirudin) form an irreversible 1:1 stoichiometric complex with thrombin.