refludan and Arterial-Occlusive-Diseases

Topics: Anticoagulants; Arterial Occlusive Diseases; Aspirin; Clopidogrel; Drug Resistance; Drug Therapy, Combination; Factitious Disorders; Female; Graft Occlusion, Vascular; Heparin, Low-Molecular-Weight; Hirudins; Humans; Iliac Artery; Middle Aged; Munchausen Syndrome; Phenprocoumon; Platelet Aggregation Inhibitors; Recombinant Proteins; Recurrence; Reoperation; Ticlopidine; Treatment Refusal; Vascular Surgical Procedures

Topics: Adenocarcinoma; Adult; Anticoagulants; Arterial Occlusive Diseases; Autoimmune Diseases; Drug Resistance; Female; Heparin; Heparin, Low-Molecular-Weight; Hepatitis C, Chronic; Hirudins; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Neoplasms, Unknown Primary; Platelet Aggregation Inhibitors; Portal Vein; Pulmonary Embolism; Recombinant Proteins; Recurrence; Thrombocytopenia; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Topics: Aged; Arterial Occlusive Diseases; Diagnosis, Differential; Fibrinolytic Agents; Heparin; Hirudin Therapy; Hirudins; Humans; Male; Recombinant Proteins; Thrombocytopenia

We report here a case of recurrent venous and arterial thromboembolism, Trousseau's syndrome, in a cancer patient who developed heparin-induced thrombocytopenia. She was treated with lepirudin and after establishing the patient-specific half-life for subcutaneous lepirudin, she was successfully maintained on this therapy for more than eight months. To our knowledge this case represents the longest reported use of subcutaneous lepirudin.

Topics: Anticoagulants; Arterial Occlusive Diseases; Female; Heparin; Hirudins; Humans; Injections, Subcutaneous; Kinetics; Middle Aged; Paraneoplastic Syndromes; Partial Thromboplastin Time; Recombinant Proteins; Recurrence; Thrombocytopenia; Thromboembolism; Venous Thrombosis

A 60-year-old woman was admitted because of acute ischemia of the right leg. The patient had been immobilized during diagnostic procedures for a thoracic paraspinal space-occupying lesion and over 5 days had received unfractionated sodium heparin by subcutaneous injection. The pedal pulses were no longer palpable.. The thrombocyte count had fallen from 207,000/microliter to 45,000/microliter. Angiography revealed occlusion of the common femoral artery. Heparin-induced platelet aggregation (HIPA) test demonstrated type II heparin-induced thrombocytopenia. Thrombectomy was performed and intraoperatively an i.v. bolus of the recombinant hirudin, lepirudin (Refludan), was given (0.2 mg/kg body weight), continual lepirudin infusion being continued postoperatively. Normal blood flow was re-established in the limb and the pedal pulse was palpable. There were no complications.. Recombinant hirudin is the only alternative licensed in Germany to heparin and seem to be suitable also for the intraoperative bolus administration in heparin-induced thromboembolic vascular occlusions.

Topics: Angiography, Digital Subtraction; Anticoagulants; Arterial Occlusive Diseases; Female; Femoral Artery; Heparin; Hirudin Therapy; Hirudins; Humans; Infusions, Intravenous; Injections, Intravenous; Intraoperative Care; Ischemia; Leg; Middle Aged; Platelet Aggregation; Platelet Count; Postoperative Care; Recombinant Proteins; Thrombectomy; Thrombocytopenia