Details of Drug-Drug Interaction
| Drug General Information (ID: DDIPVJLX85) | |||||||||
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| Drug Name | Lepirudin | Drug Info | Warfarin | Drug Info | |||||
| Drug Type | Small molecule | Small molecule | |||||||
| Therapeutic Class | Antithrombotic Agents | Anticoagulants | |||||||
| Structure | |||||||||
| Mechanism of Lepirudin-Warfarin Interaction (Severity Level: Major) | |||||||||
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| Increased risk of bleeding Click to Show/Hide Mechanism Graph | |||||||||
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| Drug Name | Lepirudin | Warfarin | |||||||
| Mechanism |
Risk of bleeding Anticoagulant |
Risk of bleeding Anticoagulant |
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| 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 |
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| Recommended Action | |||||||||
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| Management | Caution as well as close clinical and laboratory monitoring of bleeding risk are advised during coadministration of direct thrombin inhibitors and vitamin K antagonists. When converting patients from a direct thrombin inhibitor to a vitamin K antagonist such as warfarin, consider the potential for combined effects on the INR. The relationship between INR on co-therapy and warfarin alone is dependent on both the dose of the thrombin inhibitor and the thromboplastin reagent used. To avoid prothrombotic effects and to ensure continuous anticoagulation when initiating warfarin therapy, an overlap of both treatments is recommended, although the optimal duration of overlap has not been established. Warfarin therapy should be initiated using the expected daily dose, and no loading dose should be given. The INR should be monitored daily during co-therapy until the desired therapeutic range on warfarin alone is reached. Consult current guidelines for transitioning from thrombin inhibitors to warfarin and/or the manufacturer's product labeling for more detailed information. | ||||||||