Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).
Identifieur interne : 000852 ( PubMed/Curation ); précédent : 000851; suivant : 000853Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).
Auteurs : T. Schneider [Allemagne] ; B. Heuer ; A. Deller ; W H BoeskenSource :
- Wiener klinische Wochenschrift [ 0043-5325 ] ; 2000.
English descriptors
- KwdEn :
- Aneurysm, Dissecting (surgery), Anticoagulants (adverse effects), Anticoagulants (therapeutic use), Aortic Aneurysm, Abdominal (surgery), Blood Vessel Prosthesis Implantation (adverse effects), Hemodiafiltration (methods), Heparin (adverse effects), Hirudin Therapy, Hirudins (analogs & derivatives), Humans, Male, Middle Aged, Multiple Organ Failure (drug therapy), Multiple Organ Failure (etiology), Multiple Organ Failure (therapy), Recombinant Proteins (therapeutic use), Thrombocytopenia (chemically induced), Thrombocytopenia (prevention & control), Treatment Outcome.
- MESH :
- chemical , adverse effects : Anticoagulants, Heparin.
- adverse effects : Blood Vessel Prosthesis Implantation.
- chemical , analogs & derivatives : Hirudins.
- chemically induced : Thrombocytopenia.
- drug therapy : Multiple Organ Failure.
- etiology : Multiple Organ Failure.
- methods : Hemodiafiltration.
- prevention & control : Thrombocytopenia.
- surgery : Aneurysm, Dissecting, Aortic Aneurysm, Abdominal.
- chemical , therapeutic use : Anticoagulants, Recombinant Proteins.
- therapy : Multiple Organ Failure.
- Hirudin Therapy, Humans, Male, Middle Aged, Treatment Outcome.
Abstract
A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin). An ischemia of the left leg occurred at the third postoperative day. The initial platelet count was 99,000/microliter. Continuous haemofiltration (CVVH) was started three days later. Thrombotic obstructions of haemodialysis filters and catheters occurred frequently and heparin-induced thrombocytopenia (HIT II) was suspected. Antibodies against heparin were found in the HIPA test. Despite heparin free citrate dialysis and anticoagulation with danaparoid thrombotic obstructions of filters and catheters continued. Therefore the anticoagulation therapy during CVVH was changed to recombinant hirudin (lepirudin). Starting dose was a bolus of 0.01 mg/kg bw followed by the same amount as maintenance dose per hour. Anticoagulation was adjusted to an increase of aPTT (activated partial thromboplastin time) to 1.5-2 times its normal value. A dose of 0.005 mg/kg bw/h lepirudin was sufficient to maintain adequate anticoagulation. After changing to lepirudin no further catheter obstructions were observed and the platelets recovered slowly. Renal function improved and five weeks after admission endogenous creatinine clearance showed a value of 25 ml/min. We conclude that lepirudin is an effective anticoagulant during CVVH in patients with HIT II. In partly permeable polysulfon filters a dose of 0.005 mg/kg bw/h lepirudin is sufficient to maintain adequate anticoagulation. Monitoring anticoagulation by measuring the increase of aPTT (factor 1.5-2.0) seems to be safe. However, optimally the r-hirudin concentration should be measured directly using the Ecarin clotting time.
PubMed: 10953874
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Deller</name></author><author><name sortKey="Boesken, W H" sort="Boesken, W H" uniqKey="Boesken W" first="W H" last="Boesken">W H Boesken</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2000">2000</date><idno type="RBID">pubmed:10953874</idno><idno type="pmid">10953874</idno><idno type="wicri:Area/PubMed/Corpus">000852</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000852</idno><idno type="wicri:Area/PubMed/Curation">000852</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000852</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).</title><author><name sortKey="Schneider, T" sort="Schneider, T" uniqKey="Schneider T" first="T" last="Schneider">T. Schneider</name><affiliation wicri:level="1"><nlm:affiliation>II. Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Trier, Federal Republic of Germany. BKT-Med2@T-Online.de</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>II. Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Trier</wicri:regionArea></affiliation></author><author><name sortKey="Heuer, B" sort="Heuer, B" uniqKey="Heuer B" first="B" last="Heuer">B. Heuer</name></author><author><name sortKey="Deller, A" sort="Deller, A" uniqKey="Deller A" first="A" last="Deller">A. Deller</name></author><author><name sortKey="Boesken, W H" sort="Boesken, W H" uniqKey="Boesken W" first="W H" last="Boesken">W H Boesken</name></author></analytic><series><title level="j">Wiener klinische Wochenschrift</title><idno type="ISSN">0043-5325</idno><imprint><date when="2000" type="published">2000</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aneurysm, Dissecting (surgery)</term><term>Anticoagulants (adverse effects)</term><term>Anticoagulants (therapeutic use)</term><term>Aortic Aneurysm, Abdominal (surgery)</term><term>Blood Vessel Prosthesis Implantation (adverse effects)</term><term>Hemodiafiltration (methods)</term><term>Heparin (adverse effects)</term><term>Hirudin Therapy</term><term>Hirudins (analogs & derivatives)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multiple Organ Failure (drug therapy)</term><term>Multiple Organ Failure (etiology)</term><term>Multiple Organ Failure (therapy)</term><term>Recombinant Proteins (therapeutic use)</term><term>Thrombocytopenia (chemically induced)</term><term>Thrombocytopenia (prevention & control)</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anticoagulants</term><term>Heparin</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Blood Vessel Prosthesis Implantation</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analogs & derivatives" xml:lang="en"><term>Hirudins</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Thrombocytopenia</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Multiple Organ Failure</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Multiple Organ Failure</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Hemodiafiltration</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Thrombocytopenia</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Aneurysm, Dissecting</term><term>Aortic Aneurysm, Abdominal</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anticoagulants</term><term>Recombinant Proteins</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Multiple Organ Failure</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Hirudin Therapy</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin). An ischemia of the left leg occurred at the third postoperative day. The initial platelet count was 99,000/microliter. Continuous haemofiltration (CVVH) was started three days later. Thrombotic obstructions of haemodialysis filters and catheters occurred frequently and heparin-induced thrombocytopenia (HIT II) was suspected. Antibodies against heparin were found in the HIPA test. Despite heparin free citrate dialysis and anticoagulation with danaparoid thrombotic obstructions of filters and catheters continued. Therefore the anticoagulation therapy during CVVH was changed to recombinant hirudin (lepirudin). Starting dose was a bolus of 0.01 mg/kg bw followed by the same amount as maintenance dose per hour. Anticoagulation was adjusted to an increase of aPTT (activated partial thromboplastin time) to 1.5-2 times its normal value. A dose of 0.005 mg/kg bw/h lepirudin was sufficient to maintain adequate anticoagulation. After changing to lepirudin no further catheter obstructions were observed and the platelets recovered slowly. Renal function improved and five weeks after admission endogenous creatinine clearance showed a value of 25 ml/min. We conclude that lepirudin is an effective anticoagulant during CVVH in patients with HIT II. In partly permeable polysulfon filters a dose of 0.005 mg/kg bw/h lepirudin is sufficient to maintain adequate anticoagulation. Monitoring anticoagulation by measuring the increase of aPTT (factor 1.5-2.0) seems to be safe. However, optimally the r-hirudin concentration should be measured directly using the Ecarin clotting time.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">10953874</PMID><DateCreated><Year>2000</Year><Month>09</Month><Day>28</Day></DateCreated><DateCompleted><Year>2000</Year><Month>09</Month><Day>28</Day></DateCompleted><DateRevised><Year>2016</Year><Month>11</Month><Day>24</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0043-5325</ISSN><JournalIssue CitedMedium="Print"><Volume>112</Volume><Issue>12</Issue><PubDate><Year>2000</Year><Month>Jun</Month><Day>16</Day></PubDate></JournalIssue><Title>Wiener klinische Wochenschrift</Title><ISOAbbreviation>Wien. Klin. Wochenschr.</ISOAbbreviation></Journal><ArticleTitle>Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).</ArticleTitle><Pagination><MedlinePgn>552-5</MedlinePgn></Pagination><Abstract><AbstractText>A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin). An ischemia of the left leg occurred at the third postoperative day. The initial platelet count was 99,000/microliter. Continuous haemofiltration (CVVH) was started three days later. Thrombotic obstructions of haemodialysis filters and catheters occurred frequently and heparin-induced thrombocytopenia (HIT II) was suspected. Antibodies against heparin were found in the HIPA test. Despite heparin free citrate dialysis and anticoagulation with danaparoid thrombotic obstructions of filters and catheters continued. Therefore the anticoagulation therapy during CVVH was changed to recombinant hirudin (lepirudin). Starting dose was a bolus of 0.01 mg/kg bw followed by the same amount as maintenance dose per hour. Anticoagulation was adjusted to an increase of aPTT (activated partial thromboplastin time) to 1.5-2 times its normal value. A dose of 0.005 mg/kg bw/h lepirudin was sufficient to maintain adequate anticoagulation. After changing to lepirudin no further catheter obstructions were observed and the platelets recovered slowly. Renal function improved and five weeks after admission endogenous creatinine clearance showed a value of 25 ml/min. We conclude that lepirudin is an effective anticoagulant during CVVH in patients with HIT II. In partly permeable polysulfon filters a dose of 0.005 mg/kg bw/h lepirudin is sufficient to maintain adequate anticoagulation. Monitoring anticoagulation by measuring the increase of aPTT (factor 1.5-2.0) seems to be safe. However, optimally the r-hirudin concentration should be measured directly using the Ecarin clotting time.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Schneider</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>II. Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Trier, Federal Republic of Germany. BKT-Med2@T-Online.de</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Heuer</LastName><ForeName>B</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>Deller</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Boesken</LastName><ForeName>W H</ForeName><Initials>WH</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Austria</Country><MedlineTA>Wien Klin Wochenschr</MedlineTA><NlmUniqueID>21620870R</NlmUniqueID><ISSNLinking>0043-5325</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000925">Anticoagulants</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006629">Hirudins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011994">Recombinant Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>9005-49-6</RegistryNumber><NameOfSubstance UI="D006493">Heparin</NameOfSubstance></Chemical><Chemical><RegistryNumber>Y43GF64R34</RegistryNumber><NameOfSubstance UI="C083544">lepirudin</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000784" MajorTopicYN="N">Aneurysm, Dissecting</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000925" MajorTopicYN="N">Anticoagulants</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017544" MajorTopicYN="N">Aortic Aneurysm, Abdominal</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019917" MajorTopicYN="N">Blood Vessel Prosthesis Implantation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017583" MajorTopicYN="N">Hemodiafiltration</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006493" MajorTopicYN="N">Heparin</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D024764" MajorTopicYN="N">Hirudin Therapy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006629" MajorTopicYN="N">Hirudins</DescriptorName><QualifierName UI="Q000031" MajorTopicYN="Y">analogs & derivatives</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009102" MajorTopicYN="N">Multiple Organ Failure</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011994" MajorTopicYN="N">Recombinant Proteins</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013921" MajorTopicYN="N">Thrombocytopenia</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="Y">chemically induced</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2000</Year><Month>8</Month><Day>23</Day><Hour>11</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2000</Year><Month>9</Month><Day>30</Day><Hour>11</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2000</Year><Month>8</Month><Day>23</Day><Hour>11</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">10953874</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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