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Cas cliniques NACO - Congrès SJBM 2013 Marseille

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Présentations de cas cliniques de patients sous NACO par Nader Ezzedine lors du Congrès National annuel du SJBM à Marseille en décembre 2013

Publié dans : Santé & Médecine
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Cas cliniques NACO - Congrès SJBM 2013 Marseille

  1. 1. Cas cliniques NACO Ezzedine Nader
  2. 2. insuffisance rénale • Homme 78 ans, Neurochirurgie non programmée; pas de saignements. • Traitement: Rivaroxaban 20mg/j pour FA • Cl créat= 60 ml/min  maladie rénale chronique à la limite de l’IR modérér 36 h après dernière prise 55h après dernière prise antiXa Rivaroxaban 134 ng/ml 50 ng/ml TP 34% 53 % TCA ratio 1.4 1.1 cofacteurs II 0.63 UI/ml 0.79 UI/ml X 0.63 UI/ml 0.87 UI/ml V 0.55 UI/ml 0.62 UI/ml Fibrinogène 3.78 g/l 4.11 g/l T1/2 du Rivaroxban = 11h  à 5 T1/2, présence de 50 ng/ml de Rivaroxaban Pour rappel: 5 T1/2  élimination de 97% d’un molécule
  3. 3. surdosage massif • Homme 73 ans • Admis en réa pour hémorragie digestive engageant le pronostic vital • Traitement: Dabigatran 110mg X2/j pour FA • ATCD: Cancer du poumon traité par chimiothérapie (cisplatine) • Cl créat= 70 ml/min  Traitement en urgence: 2 culots de GR + 2 culots PFC Dosage Résultat anti IIa Dabigatran 3500 ng/ml TP 7% Cof II 0.02 UI/ml X 0.14 UI/m V 0.31 UI/m TCK Patient 149 sec Témoin 30 sec Ratio 5.0 TCA Patient >150 sec Témoin 30 sec Ratio >5.0 TT > 60 sec Fibrinogène 3.72 g/l
  4. 4. Interaction Rivaroxaban/HBPM et difficulté d’interpretation 0 10 20 30 40 50 60 70 80 90 0 5 10 15 20 25 Suivi Axa croisé Riv/HBPM ng/ml Axa Riv = 80.58 ng/ml Axa Riv = 18.85 ng.ml Axa Riv = 63.29 ng/ml Injection Lovenox 4000 UI Homme 70 ans, doit subir un double pontage coronarien Cl créat: 53 ml/min  IR modéree Dosage Rivaroxaban à J+3 de l’arrêt du traitement Injection d’une HBPM faussant le dosage Axa Riv  conséquence: Chirurgie repoussée de 24h
  5. 5. Tests d’hémostases pour différentes concentrations de Rivaroxaban Anti Xa Xarelto ng/ml TCA TP TT 302,84 1,1 49 32 170,4 1,4 54 30 83,34 1,5 47 26 47,09 1,1 96 32 6,77 1,2 87 31
  6. 6. Tests d’hémostases pour différentes concentrations de Dabigatran Anti IIa Dabigatran ng/ml TCA TP TT 426 2,6 35 >60 235 2,3 47 >60 137 2 56 >60 84 1,2 74 >60 41 1,5 66 >60 11 1,3 89 >60 0 1.1 106 >60

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