Rekombinantes Hirudin zur weiteren Antikoagulation bei Patienten mit Heparin-induzierter Thrombozytopenie

A Greinacher

doi:10.1055/s-0038-1660374

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 1999; 19(01): 19-29
DOI: 10.1055/s-0038-1660374

Übersichtsarbeiten/Review Articles

Schattauer GmbH

Rekombinantes Hirudin zur weiteren Antikoagulation bei Patienten mit Heparin-induzierter Thrombozytopenie

Authors

A Greinacher

¹Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität Greifswald

Abstract

Zusammenfassung

Hirudin ist ein spezifischer Thrombininhibitor, der unabhängig von Kofaktoren wie Antithrombin und Heparin-Kofaktor II wirkt. Im Gegensatz zu Heparin wird r-Hirudin durch PF4 nicht inaktiviert. Hirudin bewirkt auch eine Hemmung von Thrombus-gebundenem Thrombin und von an Fibrinabbauprodukte gebundenem Thrombin, das vor einer Hemmung durch Heparin geschützt ist. Bei der Heparin-induzierten Thrombozytopenie (HIT) führt eine verstärkte Iη-vivo-Thrombozyten-aktivierung zur Freisetzung großer Mengen von PF4 und zur exzessiven Thrombinbildung. Betroffene Patienten müssen weiter parenteral antikoaguliert werden. Zur Beurteilung des klinischen Potentials von Hirudin bei dieser Indikation führten wir zwei prospektive Multizenterstudien mit 82 und 112 Patienten durch. In diesen Studien ermöglichte das Hirudin Lepirudin eine effektive parenterale Antikoagulation von HIT-Patienten. Durch Lepirudin kann die Inzidenz schwerwiegender Folgen der HIT reduziert werden. Blutungskomplikationen und die Induktion von Anti-Hirudin-Antikörper sind die wichtigsten unerwünschten Wirkungen der Therapie mit Hirudin.

Schlüsselwörter

Heparin - Hirudin - Heparin-induzierte Thrombozytopenie - Therapie

Volltext

Referenzen

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