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(Circulation. 1995;92:2359-2363.)
© 1995 American Heart Association, Inc.

Articles

Meeting Highlights

The 1995 European Society of Cardiology

James J. Ferguson, III, MD

From studies presented at the 17th Congress of the European Society of Cardiology, August 20 to August 24, 1995, in Amsterdam, the Netherlands.

Key Words: anticoagulants • heart failure • thrombolysis • stroke • valves • angina • hirudin • angioplasty • heparin

	Hirudin Use in Heparin-Associated Thrombocytopenia

 
At a Satellite Symposium sponsored by Behring, Prof Andreas Greinacher from Ernst-Morris-Arndt University in Greifswald, Germany, presented the results of a prospective open-label evaluation of the direct thrombin inhibitor, hirudin, in achieving therapeutic levels of anticoagulation in patients with heparin-associated thrombocytopenia. The primary end point of the study was the ability to achieve adequate anticoagulation (activated partial thromboplastin time 1.5 to 3 secondsxcontrol). All patients had to have a need for procedural anticoagulation but at the same time have a documented positive heparin-induced platelet activation assay. A total of 82 patients have been enrolled to date (52 women, 30 men), with a mean age of 61.5 years. Four different hirudin regimens have been used, depending on the indication for anticoagulation: 0.4 mg/kg bolus, 0.15 mg · kg^-1 · h^-1 infusion (for thromboembolism without thrombolysis, n=49); 0.2 mg/kg bolus, 0.1 mg · kg^-1 · h^-1 infusion (for thromboembolism with thrombolysis, n=6); 0.1 mg · kg^-1 · h^-1 infusion (for prophylaxis of new thromboembolism, n=19); and 0.2 mg/kg heart-lung machine prime, 0.25 mg/kg bolus, 5 mg additional bolus (for cardiopulmonary bypass, n=8). Sixty-three patients had acute heparin-associated thrombocytopenia, with a decrease in platelet count to <100 000/µL or a decrease of 30% of baseline. The duration of hirudin treatment ranged from 3 to 59 days (median, 10 days).

Effective anticoagulation was achieved in the majority of patients. Five patients (6%) had new thromboembolic complications, 7 patients (8%) had major bleeding events, and 3 patients (4%) had to undergo limb amputation because of . . . [Full Text of this Article]

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