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Lepirudin Use in a Neonate with Heparin-Induced Thrombocytopenia

Neonatal Pharmacotherapy Fellow, Neonatal Intensive Care, The Women's Hospital of Greensboro, Moses Cone Health System, Greensboro, NC

Peter Gal, PharmD BCPS FCCP FASHP

Director, Pharmacy Division, Greensboro Area Health Education Center; Clinical Professor, School of Pharmacy, University of North Carolina; Moses Cone Health System, Greensboro Area Health Education Center, Greensboro

J Laurence Ransom, MD

Director, Neonatal Intensive Care, The Women's Hospital of Greensboro, Moses Cone Health System

Rita Carlos, MD

Neonatologist, Neonatal Intensive Care, The Women's Hospital of Greensboro, Moses Cone Health System

Reprints: Peter Gal PharmD BCPS FCCP FASHP, Moses Cone Health System, Greensboro Area Health Education Center, 200 E. Northwood St., Greensboro, NC 27401-1020, FAX 336/832-7591, E-mail peter.gal{at}mosescone.com

OBJECTIVE: To describe a case of heparin-induced thrombocytopenia (HIT) in a premature infant and the doses of danaparoid and lepirudin needed to achieve appropriate therapeutic endpoints.

CASE SUMMARY: A 30-week gestational age infant was diagnosed with HIT with heparin antibodies. Danaparoid 2.0–2.4 units/kg/h achieved anti-Xa levels of 0.2–0.4 U/mL, but thrombocytopenia failed to resolve. Lepirudin was started in place of danaparoid. Lepirudin doses of 0.03–0.05 mg/kg/h achieved target activated partial thromboplastin time values of 1.5–2.0 times baseline.

DISCUSSION: Dosing information for danaparoid in neonates is limited, and information for lepirudin appears only in German literature at this time. HIT is well documented in newborns, and lepirudin use in these situations is likely to increase. This report provides some guidance for optimal dosing. It also provides some guidance for HIT evaluation in preterm infants, in whom blood volume for laboratory tests is a major issue.

CONCLUSIONS: HIT is an important and potentially fatal problem in neonates. Lepirudin may be the drug of choice, especially since danaparoid is now unavailable. Initial lepirudin dosing should not exceed 0.05 mg/kg/h.

Key Words: danaparoid, heparin-induced, lepirudin, neonate, thrombocytopenia

Published Online, January 9, 2003. www.theannals.com, DOI

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