Severe anaphylactic reaction after repeated intermittent exposure to lepirudin

被引:12
作者
Veach, Sidney A.
Franks, Amy M.
Allan, Michael C.
机构
[1] Univ Arkansas Med Sci, Dept Pharm Practice, Coll Pharm, Little Rock, AR 72205 USA
[2] Univ Arkansas Med Sci, Div Cardiovasc Med, Coll Med, Little Rock, AR 72205 USA
来源
PHARMACOTHERAPY | 2007年 / 27卷 / 05期
关键词
lepirudin; anaphylaxis; drug reaction;
D O I
10.1592/phco.27.5.760
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Lepirudin, a recombinant DNA derivative of hirudin, is used to prevent thromboembolic complications caused by heparin-induced thrombocytopenia type II. Anaphylactic and anaphylactoid reactions have been reported with its use in patients both with and without known previous exposure to lepirudin. We describe the case of a 57-year-old woman who received five uneventful courses of lepirudin therapy before having a severe anaphylactic reaction during administration of the intravenous bolus dose that began her sixth course. The patient experienced cardiorespiratory arrest but recovered from the reaction. The decision to administer lepirudin to a patient who has previously received it should be reached with due consideration of the risk:benefit ratio and strategies to manage risk resulting from readministration. Risk factors for an anaphylactic reaction to lepirudin may include use of an initial bolus dose, intravenous rather than subcutaneous administration, length of any single course of therapy beyond 3 days, and repeat administration of lepirudin within 100 days.
引用
收藏
页码:760 / 765
页数:6
相关论文
共 20 条
[1]   Excessive anticoagulation and anaphylactic reaction after rechallenge with lepirudin in a patient with heparin-induced thrombocytopenia [J].
Badger, NO ;
Butler, K ;
Hallman, LC .
PHARMACOTHERAPY, 2004, 24 (12) :1800-1803
[2]  
*BERL LAB, 2004, REFL LEP PACK INS
[3]   Acute urticaria caused by subcutaneous recombinant hirudin: Evidence for an IgG-mediated hypersensitivity reaction [J].
Bircher, AJ ;
Czendlik, CH ;
Messmer, SL ;
Muller, P ;
Howald, H .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1996, 98 (05) :994-996
[4]   Risk of anaphylaxis after reexposure to intravenous lepirudin in patients with current or past heparin-induced thrombocytopenia [J].
Cardenas, GA ;
Deitcher, SR .
MAYO CLINIC PROCEEDINGS, 2005, 80 (04) :491-493
[5]   Heparin-induced thrombocytopenia [J].
Chong, BH .
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2003, 1 (07) :1471-1478
[6]   Treatment of heparin-induced thrombocytopenia [J].
Dager, WE ;
White, RH .
ANNALS OF PHARMACOTHERAPY, 2002, 36 (03) :489-503
[7]  
Eichler P, 2000, BLOOD, V96, P2373
[8]   Antibodies against lepirudin are polyspecific and recognize epitopes on bivalirudin [J].
Eichler, P ;
Lubenow, N ;
Strobel, U ;
Greinacher, A .
BLOOD, 2004, 103 (02) :613-616
[9]   Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia [J].
Greinacher, A ;
Lubenow, N ;
Eichler, P .
CIRCULATION, 2003, 108 (17) :2062-2065
[10]   Lepirudin (recombinant hirudin) for parenteral anticoagulation in patients with heparin-induced thrombocytopenia [J].
Greinacher, A ;
Janssens, U ;
Berg, G ;
Böck, M ;
Kwasny, H ;
Kemkes-Matthes, B ;
Eichler, P ;
Völpel, H ;
Pötzsch, B ;
Luz, M .
CIRCULATION, 1999, 100 (06) :587-593