Desirudin

Desirudin Brand Name– Iprivask

What is Desirudin

Desirudin is a parenteral bivalent recombinant analog of the natural thrombin inhibitor hirudin.

Hirudin is secreted in the saliva of the medicinal leech, Hirudo medicinalis and has a 65-amino acid structure.

Desirudin, which is expressed in yeast (Saccharomyces cerevisiae, strain TR 1456) by recombinant DNA technology, differs from natural hirudin in the absence of a sulfate group on Try-63. Desirudin has been shown to be more effective than enoxaparin in preventing DVT following total hip replacement.

Because desirudin does not bind to plasma proteins, it appears to offer more consistent anticoagulation than heparin.

Desirudin appears useful in patients with acute coronary syndromes; however, the role of desirudin for these indications remains to be defined. Two studies have implied that the advantage of desirudin over heparin exists at the time of the coronary event.

A significant early reduction in mortality and non-fatal reinfarction at 24 hours was seen with desirudin compared with heparin in patients with acute myocardial infarction or unstable angina in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial; however, desirudin was not associated with an improved outcome at 30 days compared with heparin.

In a head-to-head comparison with heparin in patients with unstable angina and undergoing percutaneous transluminal coronary angioplasty (PTCA), significantly fewer early cardiac events occurred with desirudin, however long-term follow-up showed no differences between the 2 treatments.

The ACCP antithrombotic guidelines recommend against the use direct thrombin inhibitors (e.g., desirudin) for routine initial antithrombotic treatment of acute coronary syndrome (ACS) associated with unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI).

This recommendation is based on limitations of clinical trials of direct thrombin inhibitors in ACS and the complexity of use of these agents relative to alternative antithrombotics such as unfractionated heparin and low-molecular-weight heparin.

Desirudin was FDA-approved in April 2003 for deep venous thrombosis (DVT) prophylaxis in patients undergoing total hip replacement; the drug is also approved for use in Europe.

Indications

  1. acute myocardial infarction, NSTEMI
  2. acute myocardial infarction, STEMI
  3. deep venous thrombosis (DVT) prophylaxis
  4. percutaneous transluminal coronary angioplasty (PTCA)
  5. unstable angina

For deep venous thrombosis (DVT) prophylaxis in patients undergoing elective hip replacement surgery

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. antibody formation
  4. bleeding
  5. dizziness
  6. edema
  7. epistaxis
  8. fever
  9. GI bleeding
  10. hematemesis
  11. hematoma
  12. hematuria
  13. hypotension
  14. impaired wound healing
  15. injection site reaction
  16. intracranial bleeding
  17. nausea
  18. ocular hemorrhage
  19. phlebitis
  20. retroperitoneal bleeding
  21. skin irritation
  22. spinal hematoma
  23. thrombosis
  24. vomiting

Monitoring Parameters

  • activated partial thromboplastin time (APTT)
  • hemoglobin/hematocrit
  • platelet count
  • serum creatinine
  • stool guaiac
  • urinalysis

Contraindications

  • aneurysm
  • bleeding
  • breast-feeding
  • children
  • coagulopathy
  • diabetic retinopathy
  • diverticulitis
  • endocarditis
  • epidural anesthesia
  • geriatric
  • GI bleeding
  • hemophilia
  • hepatic disease
  • hypertension
  • infants
  • inflammatory bowel disease
  • intracranial bleeding
  • intramuscular administration
  • intramuscular injections
  • labor
  • lumbar puncture
  • menstruation
  • neonates
  • obstetric delivery
  • organ biopsy
  • peptic ulcer disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • retinal bleeding
  • retroperitoneal bleeding
  • spinal anesthesia
  • stroke
  • surgery
  • trauma
  • vitamin K deficiency

Desirudin is contraindicated in patients with known hypersensitivity to natural or recombinant hirudins (hirudin hypersensitivity).

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Ado-Trastuzumab emtansine
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Anagrelide
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Argatroban
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Betrixaban
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bivalirudin
  • Caplacizumab
  • Carbenicillin
  • Chlorambucil
  • Choline Salicylate; Magnesium Salicylate
  • Cilostazol
  • Citalopram
  • Clofarabine
  • Clopidogrel
  • Collagenase
  • Cytarabine, ARA-C
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Danazol
  • Dasatinib
  • Decitabine
  • Deferasirox
  • Defibrotide
  • Denileukin Diftitox
  • Dextran
  • Dipyridamole
  • Drotrecogin Alfa
  • Edoxaban
  • Eltrombopag
  • Enoxaparin
  • Epoprostenol
  • Eptifibatide
  • Escitalopram
  • Esterified Estrogens; Methyltestosterone
  • Estramustine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Floxuridine
  • Fluorouracil, 5-FU
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluvoxamine
  • Folate analogs
  • Fondaparinux
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • Green Tea
  • Hemin
  • Heparin
  • Hydroxyurea
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Icosapent ethyl
  • Iloprost
  • Imatinib
  • Inotersen
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intravenous Lipid Emulsions
  • Lepirudin
  • Lomustine, CCNU
  • Magnesium Salicylate
  • Methoxsalen
  • Methylsulfonylmethane, MSM
  • Methyltestosterone
  • Mifepristone
  • Miltefosine
  • Mycophenolate
  • Nandrolone Decanoate
  • Natural Antineoplastics
  • Nelarabine
  • Nintedanib
  • Nonsteroidal antiinflammatory drugs
  • Obinutuzumab
  • Omacetaxine
  • Oxandrolone
  • Paroxetine
  • Pentosan
  • Phentermine; Topiramate
  • Piperacillin
  • Piperacillin; Tazobactam
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prasugrel
  • Rivaroxaban
  • Salicylates
  • Salsalate
  • Selective serotonin reuptake inhibitors
  • Serotonin norepinephrine reuptake inhibitors
  • Sertraline
  • Sodium Iodide
  • Sulfinpyrazone
  • Telavancin
  • Thrombolytic Agents
  • Ticagrelor
  • Ticarcillin
  • Ticarcillin; Clavulanic Acid
  • Ticlopidine
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Topiramate
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Vorinostat
  • Vortioxetine
  • Warfarin
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