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The Annals of Pharmacotherapy: Vol. 37, No. 5, pp. 652-654. DOI 10.1345/aph.1C187
© 2003 Harvey Whitney Books Company.
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OBJECTIF: Rapporter les cas de 4 patients devenus anticoagulés de façon excessive lors de l'utilisation d'argatroban à dose recommandée ou même moindre pour le traitement d'une thrombocytopénie à l'héparine de type II dans une unité de soins intensifs cardiothoraciques.

RÉSUMÉ: Quatre patients furent traités avec l'argatroban une fois le diagnostic de thrombocytopénie induite par l'héparine (type II) confirmé. Dans 3 cas, l'argatroban fut initié à la dose recommandée de 2 µg/kg/min et dans l'autre cas, une dose de 1 µg/kg/min fut utilisée. Ces 4 patients avaient une fonction hépatique normale. Dans tous les cas, le temps de thromboplastine activée (PTTa) était suprathérapeutique, et dans 3 cas, le PTTa était supérieur à 100 secondes. De plus, la clairance de l'argatroban semble prolongée à l'arrêt de la thérapie.

DISCUSSION: La pharmacocinétique de l'argatroban auprès de patients aux soins intensifs n'a pas été évaluée. Notre série de 4 cas démontre le potentiel d'anticoagulation excessive pouvant survenir chez cette population de patients malgré une fonction hépatique normale. Une évaluation de causalité révèle que cet effet secondaire était probablement causé par l'administration d'argatroban.

CONCLUSIONS: Une évaluation pharmacocinétique de l'argatroban est nécessaire chez les patients aux soins intensifs en vue d'optimiser la thérapie, tout en minimisant ces effets secondaires.




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This Article
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Copyright © 2003 by Harvey Whitney Books Company.