Lubenow N, Greinacher A
Department of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany.
BioDrugs. 2000 Aug;14(2):109-25. doi: 10.2165/00063030-200014020-00005.
Recombinant hirudins have a definite role in the treatment of patients with heparin-induced thrombocytopenia (HIT). The most important adverse effects are haemorrhages and the induction of antihirudin antibodies. Major haemorrhages were not significantly increased in patients with HIT compared with a historical control group, but prospective data comparing hirudin and heparinoids such as danaparoid are lacking. The definition of the optimal method for monitoring and the availability of an antidote for hirudin would probably increase safety with this drug. To date, haemofiltration using high-flux filter systems is the only way to remove an overdosage of hirudin from the circulation. In patients with renal impairment requiring hirudin treatment, it therefore seems safer to start with a low dose that is subsequently adjusted according to the activated partial prothromboplastin time or ecarin clotting time. Even in special circumstances, such as cardiopulmonary bypass or dialysis, hirudins can be applied successfully if care is taken to monitor their effects meticulously. There are many other indications in which hirudins have shown feasibility (e.g. acute coronary syndromes) but available data preclude definite conclusions.
重组水蛭素在肝素诱导的血小板减少症（HIT）患者的治疗中具有明确作用。最重要的不良反应是出血和抗水蛭素抗体的诱导。与历史对照组相比，HIT患者的严重出血情况并未显著增加，但缺乏比较水蛭素与类肝素（如达那肝素）的前瞻性数据。监测最佳方法的定义以及水蛭素解毒剂的可用性可能会提高该药物的安全性。迄今为止，使用高通量过滤系统进行血液滤过是从循环中清除过量水蛭素的唯一方法。因此，对于需要水蛭素治疗的肾功能不全患者，似乎从低剂量开始，随后根据活化部分凝血活酶时间或蛇毒凝血时间进行调整更为安全。即使在特殊情况下，如体外循环或透析，如果仔细监测其效果，水蛭素也可以成功应用。在许多其他适应症中，水蛭素已显示出可行性（如急性冠状动脉综合征），但现有数据无法得出明确结论。
