Heparin-induced thrombocytopenia with thromboembolic complications: meta-analysis of 2 prospective trials to assess the value of parenteral treatment with lepirudin and its therapeutic aPTT range

摘要: This meta-analysis focuses on 2 prospective studies in patients with heparin-induced thrombocytopenia (HIT) and thromboembolic complication (TEC) who were treated lepirudin (n = 113). Data compared those of a historical control group 91). The primary endpoint (combined incidence death, new TEC, limb amputation) occurred 25 lepirudin-treated (22.1%; 95% CI, 14.5%-29.8%): 11 died (9.7%; 4.9%-16.8%), 7 underwent amputation (6.2%; 2.5%-12.3%), 12 experienced TEC (10.6%; 5.8%-18.3%). risk was highest the period between diagnosis HIT start therapy event rate per patient day 6.1%). It markedly decreased to 1.3% during treatment 0.7% posttreatment period. From end follow-up, had consistently lower incidences combined than (P =.004, log-rank test), primarily because reduced for =. 005). Thrombin-antithrombin levels pretreatment (median, 43.9 microg/L) after initiation (at 24 hours +/- 6 hours; median, 9.18 microg/L.) During lepirudin, aPTT ratios 1.5 2.5 produced optimal clinical efficacy moderate bleeding, 1. 5 subtherapeutic, greater associated high bleeding risk. Bleeding events requiring transfusion significantly more frequent taking =.02). In conclusion, this provides further evidence that is an effective acceptably safe HIT.