Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.

Bernard Tardy; Thomas Lecompte; Françoise Boelhen; Brigitte Tardy-Poncet; Ismaïl Elalamy; Pierre Morange; Yves Gruel; Martine Wolf; Dominique François; Evelyne Racadot; Philippe Camarasa; Marie Thérèse Blouch; Françoise Nguyen; Sylvie Doubine; Fabienne Dutrillaux; Martine Alhenc-Gelas; Isabelle Martin-Toutain; Anne Bauters; Patrick Ffrench; Emmanuel De Maistre; Lélia Grunebaum; Christine Mouton; Marie G Huisse; Michèle Gouault-Heilmann; Veronique Lucke; Non Renseigné

doi:10.1182/blood-2006-02-001057

Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.

Bernard Tardy ¹ Thomas Lecompte ² Françoise Boelhen Brigitte Tardy-Poncet ¹ Ismaïl Elalamy ³ Pierre Morange ⁴ Yves Gruel ⁵ Martine Wolf ⁶ Dominique François ⁷ Evelyne Racadot Philippe Camarasa Marie Thérèse Blouch ⁸ Françoise Nguyen ⁹ Sylvie Doubine Fabienne Dutrillaux Martine Alhenc-Gelas Isabelle Martin-Toutain Anne Bauters Patrick Ffrench Emmanuel De Maistre Lélia Grunebaum ¹⁰ Christine Mouton ¹¹ Marie G Huisse ¹² Michèle Gouault-Heilmann Veronique Lucke Non Renseigné

1 GRT (EA 3065) - Groupe de recherche sur la thrombose

2 3S - Laboratoire Sols, Solides, Structures

3 SCDCAP - Signalisation cellulaire, dynamique circulatoire et athérosclérose précoce

4 CETE de Lyon - Centre d'études techniques de l'équipement de Lyon

5 Pathologies Respiratoires : Protéolyse et Aérosolthérapie

6 Institute of Neuropathology

7 LCPC/DDGC - Division Démarches durables en Génie civil

8 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale

9 LSI - UMR 7642 - Laboratoire des Solides Irradiés

10 Laboratoire d'hématologie

11 ADEME

12 Service d'hématologie et immunologie

Abstract : The antithrombotic efficacy of lepirudin in patients with heparin-induced thrombocytopenia (HIT) is compromised by an increased risk for bleeding. A retrospective observational analysis in 181 patients (median age, 67 years) with confirmed HIT treated in routine practice with lepirudin was performed to identify predictive factors for thrombotic and bleeding complications. Lepirudin was administered at a mean (+/- SD) dose of 0.06 +/- 0.04 mg/kg/h (compared with a recommended initial dose of 0.15 mg/kg/h). Mean activated partial thromboplastin time was greater than 1.5 times baseline value in 99.4% of patients. Median treatment duration was 7.7 days. Until discharge from the hospital, 13.8% and 20.4% of patients experienced a thrombotic or a major bleeding event, respectively. On multivariate analysis, mean lepirudin dose was not a significant predictive factor for thrombosis. In contrast, mean lepirudin dose greater than 0.07 mg/kg/h, long duration of lepirudin treatment, and moderate to severe renal impairment were significant positive factors for major bleeding. Overall, these results suggest that the recommended dose of lepirudin in patients with HIT is too high; the use of reduced doses may be safer with regard to bleeding risk and does not compromise antithrombotic efficacy.

Type de document :

Article dans une revue

Blood, American Society of Hematology, 2006, 108 (5), pp.1492-6. 〈10.1182/blood-2006-02-001057〉

Domaine :

Sciences du Vivant [q-bio] / Sciences pharmaceutiques / Pharmacologie

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https://hal-ujm.archives-ouvertes.fr/ujm-00440072
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Soumis le : mercredi 9 décembre 2009 - 11:52:15
Dernière modification le : vendredi 31 août 2018 - 09:18:21

Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.

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Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.

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