Drug Interaction Report

CONTRAINDICATED: The concomitant use of heparin and direct thrombin inhibitors may increase the risk of bleeding complications due to additive or synergistic effects on the clotting cascade. Moreover, since direct thrombin inhibitors are used for the treatment of thrombosis in patients with heparin-induced thrombocytopenia (HIT) and for anticoagulation in patients with or at risk for HIT, heparin would not be indicated in these patients.

MANAGEMENT: Patients with known HIT should not receive any heparin. All formulations of heparin, including heparin lock flush, should be withdrawn prior to and during the treatment of heparin-induced thrombocytopenia. Clinicians should allow sufficient time for heparin's effect on the activated partial thromboplastin time (aPTT) to decrease prior to initiation of the thrombin inhibitor. Close clinical and laboratory observation for bleeding complications is recommended.

The recommended maximum number of medicines in the 'anticoagulants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'anticoagulants' category:

• heparin
• Refludan (lepirudin)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.