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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.

Bernard Tardy 1 Thomas Lecompte 2 Françoise Boelhen Brigitte Tardy-Poncet 1 Ismaïl Elalamy 3 Pierre-Emmanuel 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 - Laboratoire des Solides Irradiés
10 Laboratoire d'hématologie
11 ADEME - Agence de l'Environnement et de la Maîtrise de l'Energie
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.
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https://hal-ujm.archives-ouvertes.fr/ujm-00440072
Contributor : Patrick Mismetti Connect in order to contact the contributor
Submitted on : Wednesday, December 9, 2009 - 11:52:15 AM
Last modification on : Thursday, January 27, 2022 - 3:37:15 AM

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UNIV-ST-ETIENNE | CNRS | ADEME | X-LSI | X | UNIV-BREST | GETBO | UNAM | IFSTTAR | CEA | CEREMA | UNIV-TOURS | X-DEP-PHYS | SORBONNE-UNIVERSITE | IBSAM | UNIV-PARIS7 | UDL | UNIV-PARIS | SU-MEDECINE | UGA | IRAMIS

Citation

Bernard Tardy, Thomas Lecompte, Françoise Boelhen, Brigitte Tardy-Poncet, Ismaïl Elalamy, et al.. Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin.. Blood, American Society of Hematology, 2006, 108 (5), pp.1492-6. ⟨10.1182/blood-2006-02-001057⟩. ⟨ujm-00440072⟩

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