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[Argatroban, a new antithrombotic treatment for heparin-induced thrombocytopenia application in cardiac surgery and in intensive care.]
[heparin-induced thrombocytopenia]
Although
heparin-induced
thrombocytopemia
(
HIT
)
is
uncommon
,
its
thromboembolic
complications
are
potentially
life-threatening
.
The
low
-molecular
weight
heparins
are
less
responsible
of
HIT
than
unfractionated
heparin
(
UFH
)
but
this
latter
is
still
indicated
in
some
circumstances
such
as
cardiac
surgery
.
Argatroban
,
a
selective
thrombin
inhibitor
,
recently
available
,
has
been
indicated
in
HIT
treatment
.
This
review
presents
the
main
pharmacological
characteristics
,
its
indications
and
uses
in
the
context
of
cardiac
surgery
and
in
intensive
care
medicine
.
Review
of
the
literature
in
Medline
database
over
the
past
15
years
using
the
following
keywords
:
argatroban
,
cardiac
surgery
,
circulatory
assistance
,
cardiopulmonary
bypass
.
Despite
its
short
-acting
pharmacokinetic
,
argatroban
can
not
be
recommended
during
cardiopulmonary
bypass
.
On
the
contrary
,
argatroban
is
indicated
in
many
circumstances
in
postoperative
period
of
various
cardiac
surgeries
(
on-pump
,
off-pump
,
circulatory
assistance
)
.
Nevertheless
,
after
cardiac
surgery
,
doses
have
to
be
adapted
according
to
coagulation
laboratory
testing
(
ACT
)
,
particularly
in
patients
presenting
acute
organ
failure
(
kidney
injury
,
heart
failure
,
liver
failure
)
.
This
compound
has
no
antagonist
and
is
excluded
during
severe
hepatic
failure
.
The
continuous
intravenous
administration
is
a
drawback
.
Argatroban
is
a
new
direct
competitive
thrombin
inhibitor
well
evaluated
as
treatment
of
HIT
after
cardiac
surgery
.
In
HIT
management
,
argatroban
is
an
interesting
alternative
to
lepirudin
that
is
not
anymore
available
and
danaparoid
because
of
supply
disturbances
.
Diseases
Validation
Diseases presenting
"supply disturbances"
symptom
heparin-induced thrombocytopenia
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