Lepirudin Side Effects
Applies to lepirudin: intravenous powder for injection
Hemorrhagic events have been the most common and potentially serious side effects associated with the use of lepirudin. The following were reported during controlled trials: bleeding from puncture sites and wounds (10.6% to 14.1%); anemia or isolated drop in hemoglobin concentration (12.4% to 13.1%); hematoma or unclassified hemorrhage (10.6% to 11.1%); gastrointestinal or rectal bleeding (5.1% to 5.3%); epistaxis (3.0% to 4.4%); hemothorax (0% to 3.0%); vaginal bleeding (1.5% to 1.8%); intracranial bleeding (0%). Intracranial hemorrhage (ICH) has been observed in patients with acute myocardial infarction who were started on both thrombolytic therapy and lepirudin. The overall prevalence of ICH in this population was 0.6% (7 of 1134 patients). ICH was not observed among 1168 patients who did not receive concomitant thrombolytic therapy. There has been at least one case report of thrombocytopenia.[Ref]
Other hemorrhagic events (hemoperitoneum, hemoptysis, liver bleeding, lung bleeding, mouth bleeding, retroperitoneal bleeding) each occurred in one individual among 198 patients treated with lepirudin in controlled trials.[Ref]
Serious anaphylactic reactions resulting in shock or death have been reported.[Ref]
Hypersensitivity reactions have occurred in up to 10% of patients and have included skin rashes, pruritus, urticaria, flushing, or chills (less than 1.0% to 3.5%) and airway reactions, such as cough, bronchospasm, stridor, dyspnea (up to 10%). Anaphylaxis or anaphylactoid reactions have been observed in less than 1% of patients. Approximately 53% of allergic or suspected allergic reactions occurred in patients also receiving thrombolytic therapy for acute myocardial infarction and/or contrast media for coronary angiography.[Ref]
Antihirudin antibodies have been reported in approximately 40% of heparin-induced thrombocytopenia patients receiving lepirudin. Complexation of lepirudin to these antibodies may increase the anticoagulant effect due to delayed renal elimination of active complexes. Lepirudin neutralization and allergic reactions have not been reported despite positive antibody tests. Adverse reactions following reexposure have been limited to mild skin reactions.[Ref]
Respiratory effects as a result of hypersensitivity reactions have been reported in up to 10% of patients. Symptoms included cough, bronchospasm, stridor, and dyspnea. Pneumonia has occurred in up to 4.4% of patients compared with 5.5% in control patients.[Ref]
Abnormal elevations of liver transaminases and other measurements of liver function have been reported in approximately 6% of patients.[Ref]
General side effects have included fever (4% to 6% of patients) and unspecified allergic reactions (less than 1% of patients).
The prevalence of sepsis, unspecified infections, and multiorgan failure has been similar among treated versus control patients (4.0% versus 5.5%, 2.5% versus 1.1%, and 2.0% versus 0%, respectively).[Ref]
Cardiovascular side effects have included new or worsened heart failure in up to 3% of patients. Pericardial effusion and ventricular fibrillation each have been reported in 1% of patients. Edema (facial, tongue, laryngeal, or angioedema) has been associated rarely with use of lepirudin.[Ref]
New or worsened renal insufficiency has been observed in 1.8% to 2.5% of patients versus 4.4% among control patients.[Ref]
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2. Organization to Assess Strategies for Ischemic Syndromes (OASIS) Investigators. "Comparison of the effects of two doses of recombinant hirudin compared with heparin in patients with acute myocardial ischemia without ST elevation: a pilot study." Circulation 96 (1997): 769-77
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4. Schroeder WS, Tran MT, Gandhi PJ "Lepirudin-induced thrombocytopenia following subcutaneous administration." Am J Health Syst Pharm 66 (2009): 834-7
5. "Product Information. Refludan (lepirudin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
6. Zeymer U, von Essen R, Tebbe U, Michels HR, Jessel A, Vogt A, Roth M, Appel KF, Neuhaus KL "Recombinant hirudin and front-loaded alteplase in acute myocardial infarction: final results of a pilot study. HIT-I (hirudin for th improvement of thrombolysis)." Eur Heart J 16(suppl d) (1995): 22-7
7. Schiele F, Vuillemenot A, Kramarz P, Kieffer Y, Anguenot T, Bernard Y, Bassand JP "Use of recombinant hirudin as antithrombotic treatment in patients with heparin-induced thrombocytopenia." Am J Hematol 50 (1995): 20-5
8. Greinacher A, Lubenow N, Eichler P "Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia." Circulation 108 (2003): 2062-5
9. Bircher AJ, Czendlik CH, Messmer SL, Muller P, Howald H "Acute urticaria caused by subcutaneous recombinant hirudin: evidence for an IgG-mediated hypersensitivity reaction." J Allergy Clin Immunol 98 (1996): 994-6
10. Song XH, Huhle G, Wang LC, Hoffmann U, Harenberg J "Generation of anti-hirudin antibodies in heparin-induced thrombocytopenic patients treated with r-hirudin." Circulation 100 (1999): 1528-32
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More about lepirudin
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Interactions
- Drug class: thrombin inhibitors
Related treatment guides
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Some side effects may not be reported. You may report them to the FDA.