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The direct thrombin inhibitor hirudin

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Current use of biologicals in thrombosis and haemostasis

DOI: http://dx.doi.org/10.1160/TH07-11-0693
Issue: 2008: 99/5 (May) pp. 799-983
Pages: 819-829

The direct thrombin inhibitor hirudin

Andreas Greinacher1, Theodore E. Warkentin2

1Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany; 2Department of Pathology and Molecular Medicine, and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

Summary

This review discusses the pharmacology and clinical applications of hirudin, a bivalent direct thrombin inhibitor (DTI). Besides the current major indication for hirudin – anticoagulation of patients with heparin-induced thrombocytopenia (HIT) – the experience with hirudin in other indications, especially acute coronary syndromes, are briefly presented. Hirudins have been formally studied prior to their regulatory approval; however, important information on their side effects and relevant preventative measures only became available later. Therefore, current recommendations and dosing schedules for hirudin differ considerably from the information given in the package inserts. Drawbacks of hirudin and important precautions for avoiding potential adverse effects are discussed in detail in the third part of this review.

Keywords

Deep vein thrombosis, hirudin, thrombin, HIT

DOI

http://dx.doi.org/10.1160/TH07-11-0693

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