In case of overdose (eg, suggested by excessively high aPTT values) the risk of bleeding is increased.
No specific antidote for REFLUDAN is available. If life-threatening bleeding occurs and excessive plasma levels of lepirudin are suspected, the following steps should be followed:
- Immediately STOP REFLUDAN administration
- Determine aPTT and other coagulation levels as appropriate
- Determine hemoglobin and prepare for blood transfusion
- Follow the current guidelines for treating patients with shock
Individual clinical case reports and in vitro data suggest that either hemofiltration or hemodialysis (using high-flux dialysis membranes with a cutoff point of 50,000 daltons, eg, AN/69) may be useful in this situation.
In studies in pigs, the application of von Willebrand Factor (vWF, 66 IU/kg body weight) markedly reduced the bleeding time. The clinical significance of this data is unknown.