ABSTRACT
INTRODUCTION Lepirudin (Refl udan, produced by Cellgene, U.K.) became the fi rst direct thrombin inhibitor (DTI) available for treating heparin-induced thrombocytopenia (HIT) in 1997. While in early 2012 the Bayer Group stopped marketing lepirudin, smaller companies took over the marketing rights in some countries (e.g., Pharmore in Germany). At the time this chapter was fi nalized it remained unclear in which jurisdictions lepirudin will be available. There are two other recombinant hirudins (r-hirudins) available, desirudin (Revasc/Iprivask, Canyon Pharmaceuticals, Basel, Switzerland; available in Europe and North America) and RB variant-hirudin (Thrombexx, Rhein-Minapharm, Cairo, Egypt; available in many countries in Asia and Africa). The pharmacokinetics and biologic activities of the different r-hirudins are very similar. Thus the data obtained in preclinical and clinical studies with lepirudin in HIT may help guide the use of other r-hirudins, especially in countries where lepirudin is not/no longer available.
