Pharmacologie - Les anticoagulants

 Pharmacologie - Les anticoagulants

Les héparines standard

  • Sont des anti-thrombine

  • Action rapide (15 mn)

  • ½ vie de 2h

  • Uniquement en curatif

  • 1ml = 50 mg = 5 000 UI d'héparine

Les héparines calciques

  • Toujours en sous cutanée

  • Action en 30mn, durée max 12h

  • On ne purge pas les aiguille

Les HBPM (Héparines de Bas Poids Moléculaire)

  • Lovenox® Fraxiparine®

  • Préventif en général

  • Durée d'action 24h à une injection par 24h en préventif (2 si curatif)

Surveillance des héparines

TCA / TCK : 

  • préventif 1fois à 1fois ½ le temps témoin

  • curatif 2 à 3 fois

NFS au bout de 5 jours puis toutes les semaines (l'allergie à l'héparine se manifeste par une agglutination des plaquettes entre elles à CIVD, risque hémorragique et embolique)

Pour les HBPM la seule surveillance est la NFS (on suppose qu'elles sont efficaces, les risques de CIVD sont presques nuls).

Surveillance des AVK

  • Le TP doit être entre 25 et 35 % (N = 100%).

  • On ne donne jamais d'AVK sans connaître le TP du jour.

  • Le délai d'action est long (24h ou 36h  après la prise selon les médicaments).

  • 1 ou 2 prise par jour.

Conseils aux patients :

  • Si vous oubliez un comprimé, ne pas prendre double dose le lendemain, continuer la dose prescrite.

  • Ne jamais modifier le traitement.

  • Signaler les saignements et hématomes au médecins.

  • Ne pas prendre de pansements gastriques, laxatifs ou barbituriques sans avis médical (baisse de l'efficacité du traitement)

  • Ne pas prendre d'aspirine, de corticoïdes, d'anti-ulcéreux (Tagamet®), d'antibiotiques sans avis médical (augmentation possible des effets du traitement)

  • Prévenir tout professionnel de santé de la prise de ces médicaments.

  • Ne pas faire d'intramusculaire.

  • Éviter les choux, les épinards, les abats (riches en vitamine K).

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