The Medical Letter on Drugs and Therapeutics
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Desirudin (Iprivask) for DVT Prevention

The injectable direct thrombin inhibitor desirudin (Iprivask – Canyon), a recombinant analog of hirudin, the leech anticoagulant protein, was approved by the FDA in 2003 for prevention of venous thromboembolism (VTE) after elective hip arthroplasty, but was only marketed recently in the US. It has been available in Europe as Revasc for about 10 years. Two other hirudin analogs are available in the US: lepirudin (Refludan) for treatment of heparin-induced thrombocytopenia (HIT) and bivalirudin (Angiomax) for use in percutaneous coronary intervention (PCI).

DRUGS FOR VTE PREVENTION — Most patients undergoing elective hip arthroplasty in the US are treated parenterally with a low-molecular-weight heparin (LMWH) such as enoxaparin (Lovenox, and others) or fondaparinux (Arixtra), a synthetic analog of heparin, or orally with warfarin (Coumadin, and others). ... more      

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