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Coagulation
Therapy related coagulopathies
Hirudin
Reviewer: Jeremy Parsons, M.D. (see Reviewers page)
Revised: 21 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.
General
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● Anticoagulant approved by FDA to treat thrombosis in patients with heparin induced thrombocytopenia (does not itself cause this type of syndrome)
● Derivatives include lepirudin, refludan
● Recombinant protein, cloned from a leech (Wikipedia), which directly inhibits factor IIa (thrombin)
● Also has fibrinolytic properties
● More predictable anticoagulant effect than standard heparin, less need for laboratory monitoring, although close monitoring is still advised with PTT, though this assay has limitations (ecarin clotting time is preferable)
● Prolongs PT, PTT, thrombin time, ACT, and interferes with most clotting based assays
● Therapeutic range to treat DVT is PTT that is 1.5-2.5 x normal, but more specific assays are also used to monitor, such as ecarin clotting time
● Half-life ~one hour, may be prolonged if antibodies develop, dramatically prolonged in renal failure
● No reversal agent
Additional references
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End of Coagulation > Therapy related coagulopathies > Hirudin
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