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Hamostaseologie 2004; 24(02): 135-143
DOI: 10.1055/s-0037-1619613
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Schattauer GmbH

Lepirudin bei heparininduzierter Thrombozytopenie

Grundlagen und aktueller Erkenntnisstand zur klinischen AnwendungLepirudin for therapeutic use in heparin-induced thrombocytopenia
J. Harenberg
1   IV. Medizinische Klinik, Universitätsklinikum Mannheim
,
I. Jörg
1   IV. Medizinische Klinik, Universitätsklinikum Mannheim
,
S. Koch
1   IV. Medizinische Klinik, Universitätsklinikum Mannheim
,
T. Fenyvesi
1   IV. Medizinische Klinik, Universitätsklinikum Mannheim
› Author Affiliations
Further Information

Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Die heparininduzierte Thrombozytopenie (HIT) Typ II ist eine antikörpervermittelte unerwünschte Arzneimittelwirkung auf Heparin, die paradoxerweise mit einem Abfall der Thrombozytenkonzentration und einem erhöhten Risiko für thromboembolische Komplikationen einhergeht.

Die Antikörper reagieren gegen ein Neoepitop des Plättchenfaktors 4 nach Bindung mit Heparin. Die Inzidenz der HIT II ist geringer unter niedermolekularem Heparin im Vergleich zu unfraktioniertem Heparin und bei nicht operierten Patienten im Vergleich zu Patienten nach großen operativen Eingriffen. Bei der HIT II ist die unverzügliche Einleitung einer alternativen Antikoagulation wegen der hohen, durch Antikörper vermittelten Thrombogenität erforderlich. Das rekombinante Hirudin Lepirudin (Refludan®) ist Antikoagulanz der Wahl. Eine langfristigere Antikoagulation kann in Abhängigkeit von begleitenden Faktoren mit subkutanem Lepirudin und mit oralen Antikoagulanzien erfolgen.

Summary

Heparin-induced thrombocytopenia (HIT) type II is an antibody mediated severe adverse event to heparin with a paradoxical decrease of platelet count and an increased risk for thromboembolic complications.

The antibodies are directed against a neoepitop of platelet factor 4 after its binding to heparin. The incidence of HIT type II is lower with low-molecular-weight heparin compared to unfractionated heparin and lower in not operated patients compared to those after major surgery. In patients with HIT type II alternative anticoagulation has to be performed immediately due to the high thrombogenicity of the antibodies. The recombinant hirudin lepirudin (Refludan®) is the anticoagulant drug of choice. A long-term anticoagulation has to be performed depending on the concomitant risk factors, intravenous administration followed by subcutaneous lepirudin overlapping with vitamin K antagonists.

Schlüsselwörter

Heparininduzierte Thrombozytopenie - Plättchenfaktor 4 - Heparin - Lepirudin

Keywords

Heparin-induced thrombocytopenia - platelet factor 4 - heparin - lepirudin
 

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