Drug General Information (ID: DDI61S5ZI9)
Drug Name			Lepirudin		Drug Info		Heparin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antithrombotic Agents				Anticoagulants
Structure

Mechanism of Lepirudin-Heparin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Lepirudin				Heparin
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Lepirudin and Heparin

Recommended Action
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 All formulations of heparin, including heparin lock flush, should be withdrawn prior to and during the treatment of heparin-induced thrombocytopenia.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.

References
1	Product Information. Acova (argatroban) SmithKline Beecham, Philadelphia, PA.
2	Product Information. Refludan (lepirudin). Hoechst Marion-Roussel Inc, Kansas City, MO.