title: [Argatroban, a new antithrombotic treatment for heparin-induced thrombocytopenia application in cardiac surgery and in intensive care].
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Review of the literature in Medline database over the past 15 years using the following keywords: argatroban, cardiac surgery, circulatory assistance, cardiopulmonary bypass.
  
  
  RESULTS
  Despite its short-acting pharmacokinetic, argatroban cannot 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France. Electronic address: bertrand.rozec@chu-nantes.fr.
authors.forename: B
authors.initials: B
authors.lastname: Rozec
authors.affiliation: Laboratoire d'hématologie, CHU de Nantes, 44093 Nantes cedex 1, France.
authors.forename: E
authors.initials: E
authors.lastname: Boissier
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, groupe hospitalier Cochin-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Godier
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
authors.forename: R
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Réanimation adultes, centre chirurgicale Marie-Lannelongue, 92350 Le Plessis-Robinson, France.
authors.forename: F
authors.initials: F
authors.lastname: Stephan
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Blanloeil
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005343:Fibrinolytic Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010875:Pipecolic Acids / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban
keywords: Argatroban; Assistance circulatoire; Cardiac surgery; Chirurgie cardiaque; Circulatory assistance; Heparin-induced thrombocytopenia; Thrombopénie induite par l’héparine