Premium
A first approach to compare efficacy and safety of lepirudin and danaparoid in patients with heparin‐induced thrombocytopenia (HIT)
Author(s) -
Farner B.,
Eichler P.,
Kroll H.,
Urban G.,
Greinacher A.
Publication year - 2000
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1046/j.1365-3148.2000.00261-3.x
Subject(s) - lepirudin , medicine , heparin induced thrombocytopenia , surgery , clinical endpoint , anticoagulant , antithrombin , thrombosis , heparin , anesthesia , discovery and development of direct thrombin inhibitors , randomized controlled trial , platelet , thrombin
B ackground HIT is a hyper–coagulable syndrome requiring further anticoagulation. O bjective To compare the outcome of HIT patients treated with danaparoid or lepirudin regarding the single or combined endpoints of new thromboembolic complications (TECs), amputations and/or death, and major bleedings. M ethod Cohort study comparing HIT patients treated during the same time period with danaparoid or lepirudin. P atients The efficacy of lepirudin was investigated in two prospective trials. HIT patients, who were identified in the same two laboratories during the same time period, but who were not enrolled into these studies but treated with danaparoid, were assessed retrospectively according to a standardized questionnaire. R esults 126 danaparoid (50 male, 70 female) and 175 lepirudin treated patients (73 male, 102 female) fulfilled the same inclusion and exclusion criteria. In a time‐to‐event‐analysis the cumulative risk of combined endpoint was higher in HIT patients without thromboembolic complications at study entry treated with danaparoid as compared to lepirudin ( P = 0·02), whereas HIT patients with thrombosis at study entry had a similar outcome in both treatments groups ( P = 0·91). Major bleedings occurred in 2·5% [95% CI 0·5–7·0%] of danaparoid treated patients as compared to 10·4% [95% CI 6·3–15·9%] of lepirudin treated patients until day 42 ( P = 0·009). C onclusion The efficacies of therapeutic dosages of danaparoid or lepirudin do not differ largely, but the risk of bleedings seems to be higher in lepirudin treated patients. However the prophylactic dosage of danaparoid (750 antifactor Xa units b.i.d. or t.i.d. s.c.) approved in European Union for HIT without TEC's seems to be suboptimal.