Résumé
La surveillance biologique des héparines de bas poids moléculaires (HBPM) et du fondaparinux fait appel à la mesure de l’activité anti-Xa, rendue en UI d’anti-Xa/ml. L’arrivée sur le marché de nouveaux anticoagulants comme le rivaroxaban (Xarelto®) ayant une activité anti-Xa spécifique et directe (indépendante de l’antithrombine) suscite un intérêt pour une mesure de l’activité anti-Xa plasmatique même s’il n’y a pas actuellement d’indication à la surveillance biologique de ces nouveaux produits en routine. Ces derniers, bien que possédant une activité anti-Xa, ont des caractéristiques différentes des HBPM ou du fondaparinux. C’est pourquoi, les tests habituels de mesure de l’activité anti-Xa et l’expression des résultats présentent des limites et devront être adaptés. Actuellement, la mise au point des tests de mesure d’activité anti-Xa basés sur des principes proches de ceux que nous connaissons et permettant de rendre des concentrations plasmatiques en ng/ml de produit est en bonne voie. De futures études devraient permettre d’avancer vers une meilleure interprétation des résultats biologiques et de démontrer leur pertinence clinique.
Abstract
Biological monitoring of low molecular weight heparins (LMWH) or fondaparinux involves the measurement of anti-Xa activity, with a result in IU of anti-Xa activity/ml. New anticoagulants as rivaroxaban (Xarelto®) have been recently commercialised. This new anticoagulant has a specific and direct effect on factor Xa (independent of the presence of antithrombin). Currently, there is no indication for routine biological monitoring of these new products but there is still an interest to measure the plasmatic concentration of these products. Therefore, standard tests for measuring anti-Xa activity have limitations and should be adapted. The development of tests for measuring anti-Xa activity based on principles similar to those we know and able to give plasma concentrations in ng/ml is on track. Future studies should help to provide better interpretation of laboratory results and to demonstrate their clinical relevance.
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Flaujac, C., Guinet, C. & Samama, M.M. Dosage de l’activité anti-Xa des héparines de bas poids moléculaire (HBPM) du fondaparinux et des nouveaux anticoagulants . Bio trib. mag. 38, 22–25 (2011). https://doi.org/10.1007/s11834-011-0046-8
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DOI: https://doi.org/10.1007/s11834-011-0046-8