Antilepirudin antibodies from patients treated for heparin-induced thrombocytopenia cross-reacted with bivalirudin in 51.2% of cases, indicating polyspecificity.
Observational (n=43)
Do antilepirudin antibodies cross-react with bivalirudin in patients previously treated with lepirudin for heparin-induced thrombocytopenia?
Antilepirudin antibodies cross-react with bivalirudin in over half of patients, suggesting caution when using bivalirudin in patients previously treated with lepirudin.
Abstract Bivalirudin is a synthetic antithrombin sharing a sequence of 11 amino acids with the recombinant hirudin lepirudin. We investigated whether antilepirudin antibodies recognize epitopes on bivalirudin. Antilepirudin antibody–positive sera of 43 patients, treated with lepirudin for heparin-induced thrombocytopenia, were analyzed. Lepirudin- and bivalirudin-coated microtiter plates were used for antibody testing in an enzyme-linked immunosorbent assay (ELISA) system. Of the 43 sera-containing antibodies binding to lepirudin, 22 (51.2%) contained antibodies that also recognized bivalirudin. Binding of these antibodies to bivalirudin was inhibited by more than 70% by preincubation with high doses of bivalirudin. However, if lepirudin-coated microtiter plates were used, high concentrations of bivalirudin inhibited only 2 of the 43 positive sera by more than 30%. Therefore antihirudin antibodies must be polyspecific. The clinical consequences of this cross-reactivity are unknown but bivalirudin, targeted by antibodies of patients treated with lepirudin previously, could potentially boost antibody titers in such patients or even trigger an immune response by itself. Clinically significant antibody formation in response to bivalirudin monotherapy has not been observed, however. Yet, as lepirudin and antilepirudin antibodies have recently been implicated in severe anaphylactic reactions, caution is warranted when using bivalirudin in patients previously treated with lepirudin.
Eichler et al. (Tue,) conducted a observational in Heparin-induced thrombocytopenia (n=43). Bivalirudin (in vitro testing) was evaluated on Cross-reactivity of antilepirudin antibodies with bivalirudin. Antilepirudin antibodies from patients treated for heparin-induced thrombocytopenia cross-reacted with bivalirudin in 51.2% of cases, indicating polyspecificity.