Abstract: . . .  or weeks. Thus, an alternative anticoagulant should be substituted for heparin when HIT is strongly suspected. 1 Direct thrombin inhibition may be beneficial in managing HIT. Several acting anticoagulants able to inhibit thrombin are available. Among them, only lepirudin is currently available in Greece. Lepirudin is the recombinant form of hirudin which is a thrombin inhibitor originally isolated from the salivary gland of the medicinal leech. It is a polypeptide of 65 amino acids which is renally metabolized and excreted with a half-life of 80 min. It does not show any reactivity in vitro for heparin and heparin induced antibodies. Lepirudin inactivates not only free thrombin but also fibrin clot bound thrombin. 3 Its anticoagulation effect can be monitored by APTT and/or ecarin . . .
. . .  post-operative day. Ten days after the surgical procedure and twelve days after the angiography, the patient was readmitted to our hospital because of an acute substernal pain with electrocardiogram findings suggestive of acute myocardial infarction. On clinical examination an intense oedema with pain and redness on her right forearm was noticed. A duplex ultrasound study revealed thrombosis in the right subclavian vein. The laboratory tests were as follows: haemoglobin 7.1g/dl, white cell count 22.5x10 9 /l (neutrophils 88%, lymphocytes 8%, monocytes 4%), platelets 45x10 9 /l, coagulation tests were normal except for the presence of elevated D-Dimers, urea 38.5mmol/l (normal range 3.5-14), creatinine 371.3mol/l (normal range 44.3-105), lactate dehydrogenase (LDH) 750 iu/l . . .
. . .  thrombocytopenia and renal failure requiring hemodialysis. ann pharmacother 2001; 35(7-8): 885-90. 7. Schneider T, Heuer B, Deller A, Boesken WH. Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II). Wien Klin Wochenschr 2000; 112(12): 552-5. 8. Whelen S, Carr ME Jr. Use of recombinant hirudin in heparin-induced thrombocytopenia and thrombosis (HITT) and renal failure: a case report. angiology 2001; 52(10): 711-5. 9. Nowak G, Bucha E, Brauns I, Czerwinski R. Anticoagulation with r- hirudin in regular haemodialysis with heparin-induced thrombocytopenia (HIT II). The first long-term application of r-hirudin in a haemodialysis patient. Wien Klin Wochenschr 1997; 109(10): 354-8. 10. Fischer KG, van de Loo A, Bohler J. Recombinant hirudin (lepirudin) . . .
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