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Lepirudin, a recombinant form of the leech anticoagulant hirudin, is used for treatment of heparin-induced thrombocytopenia (HIT). Because the lepirudin dosing originally approved by the FDA proved to be too high, the American College of Chest Physicians Clinical Practice Guidelines recommend dose reduction (Chest 2008; 133(suppl):340). To establish a dose that is safe and effective, investigators in Switzerland conducted a retrospective algorithm-derivation study plus a prospective validation study of lepirudin infusions in patients with HIT.
In the retrospective study, 53 patients were given lepirudin doses based on renal function: Those with creatinine clearance (CrCl) >60 mL/minute received median doses of 0.087 mg/kg/hour, those with Cr…