CAV\/VVHD      :Unknown dialysability. Dose as for GFR =15\u201329 mL\/min IMPORTANT DRUG INTERACTIONS <\/H3>Potentially hazardous interactions with other drugsThrombolytics: may increase risk of bleeding complications; enhance effect of lepirudinAntiplatelets and anticoagulants: increased risk of bleeding complications ADMINISTRATION <\/H3> Reconstition<\/H4>1 mL water for injection or sodium chloride 0.9% Route <\/H4>IV Rate of Administration <\/H4>0.15 mg\/kg\/hour Comments<\/H4>Further dilute with sodium chloride 0.9% or glucose 5% if for infusionBolus concentration should be 5 mg\/mL and infusion 2 mg\/mLChange syringe at least every 12 hours after start of infusion OTHER INFORMATION <\/H4>Dialysed out if used with high flux polysulfone dialysers (Frank RD, Farber H, Stefandis I, et al. Hirudin elimination by hemofiltration: a comparative in vitro study of different membranes. Kidney Int suppl. 1999, Nov; 72: s41\u20135)Lepirudin may also be used for the prevention of clotting in the extracorporeal circulation during haemodialysis and haemofiltration (non-licensed indication)Dose for dialysis anticoagulation if <4.5 hr session is 0.141\u2013 0.152 mg\/kg as an IV bolus pre-dialysis. Alternative is 0.01 mg\/kg IV bolus, followed by a continuous infusion of 0.01 mg\/kg\/hour, adjusted to APTT 1.5\u20132 normal (0.005 mg\/kg\/hr was adequate). (Schneider T, Heuer B, Deller A, et al. Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia. Wien Klin Wochenschr. 2000, Jun; 112(12): 552\u20135.)Recent reports of 7 cases of severe anaphylactic reactions resulting in 5 fatalities and at least 6 of the cases were after re-exposure. In some cases it was used outside its therapeutic indication.424 LEPirUdinUse with great caution, as it cannot be reversedResults from studies in pigs have found that Von Willebrand factor 66 iu\/kg can reduce bleeding timereferences:1. Nowak G, Bucha E, Brauns I, et al. Anticoagulation with r-hirudin in regular haemodialysis with heparin-induced thrombocytopenia (HIT-II). Wien Klin Wochenschr. 1997; 109(10): 354\u201382. Van Wyk V, Badenhorst PN, Luus HG, et al. A comparison between the use of recombinant hirudin and heparin during haemodialysis. Kidney Inter. 1995; 48: 1338\u201343Significant accumulation with long-term use in renal impairment.
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