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- W1966875866 abstract "L’antagonisation rapide du traitement anticoagulant est indispensable pour le patient présentant une hémorragie menaçant le pronostic vital ou devant subir une chirurgie d’urgence. Le sulfate de protamine réverse l’effet anti-IIa de l’héparine non fractionnée. L’antagonisation est bien codifiée : chaque milligramme de sulfate de protamine antagonise 100 UI d’héparine. La correction du temps de thrombine (TT) après protamine témoigne de l’efficacité du traitement. L’opportunité d’une nouvelle perfusion (demi-dose) de protamine sera réévaluée par un nouveau TT 60 minutes après réversion. Concernant les HBPM, la protamine est indiquée, mais l’efficacité de la réversion dépend des activités relatives anti-IIa et anti-Xa, variables selon le type d’HBPM. En effet, la protamine réverse l’effet anti-II mais n’antagonise que partiellement l’activité anti-Xa. Les nouveaux anticoagulants (pentasaccharides, inhibiteurs directs de la thrombine ou du facteur Xa) font espérer une anticoagulation plus stable et une diminution des accidents iatrogènes. Cependant, ces résultats obtenus au cours d’études contrôlées peuvent sous-estimer l’observation en pratique clinique. Aucun antidote efficace n’est décrit à ce jour. Des études, animales et volontaires sains, suggèrent une certaine efficacité du facteur VIIa pour les pentasaccharides ou du CCP ou CCP activé sur l’inhibiteur direct du Xa (rivaroxaban) et du CCP, CCP activé ou facteur VII activé sur l’inhibiteur direct du IIa (dabigatran). Even with unfractionated heparin or derivates, the reversal of pharmacologic anticoagulation is crucial in anticoagulated patients developing a life-threatening bleeding or scheduled for an emergency procedure. The antagonisation of unfractionated heparin is well codified: each milligram of protamine sulfate antagonizes 100 IU of heparin. Measurement of thrombin time reflects the anti-IIa effect of heparin and has to be monitored immediately and 1 hour after the injection of protamine. The required dose of protamine sulfate depends on dosage and time of LMWH administration, although no clinical study supports these data. To date, there is no effective antidote for new anticoagulants (fondaparinux and other pentasaccharides, direct thrombin inhibitors, direct anti-Xa inhibitors). Some preliminary studies suggest the effectiveness of recombinant activated factor VII for pentasaccharides and activated or not Prothrombin Complex Concentrates and recombinant activated factor VII for oral anti-Xa and anti-IIa agents. Therefore, while the characteristics of these new anticoagulants could increase the comfort and improve the compliance, their development needs to ascertain the lack of increase in bleeding complications and the need for a safe and effective antidote." @default.
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- W1966875866 date "2013-01-01" @default.
- W1966875866 modified "2023-10-16" @default.
- W1966875866 title "Antagonisation des héparines et des nouveaux anticoagulants" @default.
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- W1966875866 doi "https://doi.org/10.1016/j.annfar.2012.10.034" @default.
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