JLE

Journal de Pharmacie Clinique

MENU

Retrospective study of danaparoid sodium use in a French teaching hospital Volume 25, issue 3, Juillet-Août-Septembre 2006

Figures

See all figures

Authors
Service de pharmacie-stérilisation, Hôpitaux universitaires de Strasbourg, Service de réanimation chirurgicale cardiovasculaire, Hôpitaux universitaires de Strasbourg

The drug committee of our institution recommended the use of danaparoid to prevent and treat thromboembolic events among patients with Heparin Induced Thrombocytopenia (HIT). The goal of our study was to assess the adherence to institutional recommendations. All the medical records of the patients treated with danaparoid were retrospectively reviewed between August 2004 and March 2005. Among 50 patients treated, 45 records were valuable. The median age was 70 years (range, 32-95 years). The prescriptions were mainly initiated in the Medical Intensive Care Unit (ICU) (27%) and the Cardiovascular Surgery ICU (20%). We observed 32 suspicions of acute HIT and 11 antecedents of HIT. The average time laps to develop the acute HIT was 9 days and was less than 5 days for 8 patients. The platelet count decrease (62% on average) was not judged sufficient in one case. Anti-PF4/heparin antibodies were detected for 5 patients among 28 searches. The median duration of treatment was 9 days (range, 1-78 days) and 33% of treatments (15/45) were relayed by oral anticoagulants. The longest duration of treatment were observed in the ICU due to an impossible oral relay. Overall, the evolution was favourable for 32 patients. Compared with our previous work (October 1998-March 2001), the number of treatments increased 7 fold with a greater HIT proportion. Although heparin-dependent antibodies were more frequently assessed, the positive results were less frequent. This lead to a consumption’s increase and could be explained by a better awareness of the medical staff. The drug committee recommendations were generally followed. This work, conducted in association with physicians, hematologists and the Center of Pharmacovigilance, lead to the creation of a document attesting the positivity to anti-heparin antibodies research. This document is delivered by hematologists to the concerned patients and the Center of Pharmacovigilance is informed.