UFH doses are then adjusted preferably according to anti-Xa activity (see below). The bolus is then followed by an initial dose of 18 IU/kg/h (IV) or 500 IU/kg/24 h in 2 to 3 injections per day (SC) ( 5). In most indications, a bolus of 80 IU/kg or 5,000 IU UFH is recommended before administration of IV or SC UFH. UFH remains the anticoagulant of choice during cardiothoracic surgery with extracorporeal circulation and in case of extracorporeal membrane oxygenation. Heparin derivatives are indicated for treatment of acute phase VTE, extra-cerebral arterial embolisms, acute coronary syndromes (ACS), hemodialysis and VTE prevention.
Four low molecular weight heparin (LMWH) compounds are commercialized in France: enoxaparin (Lovenox ® since April 1987 and Crusia ® since July 2017), tinzaparin (Innohep ® since October 1991), dalteparin (Fragmine ® since December 1987) and nadroparin (Fraxiparine ® since March 1985 and Fraxodi ® since May 1998). UFH is administered either by a continuous intravenous (IV) infusion or subcutaneously (SC) every 8 or 12 hours, respectively. Unfractionated heparin (UFH) is marketed in France as sodium (Heparin sodium Panpharma since March 1977 and Heparin Choay since December 1986) or calcium (Heparin calcium Panpharma since February 1978) salts. We hence propose in this review to go over the available anticoagulant drugs, their indications and doses, their monitoring strategies, their perioperative management as well as their reversal as proposed by French expert groups.Īnticoagulant drugs: availability and indications Heparin derivatives Anticoagulated French patients were estimated above 3 million in 2013 ( 4). Consequently, the number of patients receiving anticoagulant therapy per year is considerable in France, as worldwide, and has a substantial impact on the overall cost of health care. The incidence of VTE in the French population was estimated at 184 per 100,000 subjects in 2011 with a mortality rate of 6.2% over a 12-month follow-up ( 3). As well, the incidence and the burden of VTE, which includes pulmonary embolism and deep vein thrombosis are important and increase with age. Prevalence of NVAF in France is estimated between 1% to 2% of the general population ( 1), and increases with aging from less than 1% in people below 60 years of age to at least 8% in those above 80 years ( 2). Received: 08 October 2019 Accepted: 14 February 2020 Published: 25 March 2020.Īnticoagulant drugs are mainly prescribed for treatment and prevention of venous thromboembolism (VTE) and for stroke and systemic embolism prevention in non-valvular atrial fibrillation (NVAF) patients. Keywords: Direct oral anticoagulants (DOAC) vitamin K antagonists (VKA) heparin derivatives anticoagulant therapy France Georges Jourdi 1,2, Alexandre Mansour 3, Caroline Vayne 4,5, Alexandre Godon 6, Charles Tacquard 7, Virginie Siguret 1,8, Pierre Albaladejo 9,10, Yves Gruel 4,5, Isabelle Gouin-Thibault 11,12 French Study Group on Hemostasis and Thrombosis (GFHT) & French Working group on perioperative hemostasis (GIHP)ġ Université de Paris, Innovative Therapies in Hemostasis, INSERM, Paris, France Ģ Service d’Hématologie Biologique, AP-HP, Cochin Hospital, Paris, France ģ Department of Anaesthesiology and Critical Care, Rennes University Hospital, CIC-Inserm1414, Rennes, France Ĥ Service d'Hématologie Hémostase, Hôpital Trousseau, CHRU de Tours, Tours, France ĥ EA 7501, Université François Rabelais, Tours, France Ħ Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France ħ Department of Anesthesia and Intensive Care, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France Ĩ Service d’Hématologie Biologique, AP-HP, Lariboisière Hospital, Paris, France ĩ Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France ġ0 ThEMAS, TIMC, UMR CNRS 5525, Université Grenoble-Alpes, Grenoble, France ġ1 University of Rennes 1, CIC-Inserm1414, Rennes, France ġ2 Laboratory of Hematology, Rennes University Hospital, Rennes, FranceĬontributions: (I) Conception and design: G Jourdi, I Gouin-Thibault (II) Administrative support: None (III) Provision of study materials or patients: None (IV) Collection and assembly of data: All authors (V) Data analysis and interpretation: G Jourdi, I Gouin-Thibault (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.