Use of Idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. A multicentric experience in Spain
Por:
Crespo-Leiro, MG, Lopez-Vilella, R, Granados, AL, Mirabet-Perez, S, Diez-Lopez, C, Barge-Caballero, E, Segovia-Cubero, J, Gonzalez-Vilchez, F, Rangel-Sousa, D, Blasco-Peiro, T, de la Fuente-Gal?n, L, Diaz-Molina, B, Zatarain-Nicolas, E, Avalos, FC, Almenar-Bonet, L
Publicada:
1 dic 2019
Resumen:
Background Anticoagulation in heart transplant (HT) recipients increases the risk of hemorrhagic complications, so correct reversal of anticoagulation is needed. Dabigatran, a direct thrombin inhibitor, is increasingly used for anticoagulation in patients with non-valvular atrial fibrillation (NVAF) whose effect can be reversed by idarucizumab. Aim To present a nationwide experience using idarucizumab for the urgent reversal of dabigatran before HT. Methods Multicenter observational study in 12 Spanish centers to analyze the clinical outcomes after using idarucizumab before HT surgery. Results Fifty-three patients were included (81.1% male). 7.5% required re-operation in the immediate postoperative period to control bleeding and 66% transfusion of blood products. Median length of stay in the intensive care unit was 6 days and total hospital stay 24 days. 30-day survival was 92.4%. There were four deaths in the first month, all in the first 5 days post-HT. Only in one patient (transplanted due to a congenital heart disease, after sternotomy) who had surgical problems and right ventricular failure post-HT death was associated with bleeding. Conclusions These results may support the use of dabigatran as an alternative to vitamin K antagonists in patients listed for HT requiring anticoagulation due to NVAF. More studies are needed to reaffirm these observations.
Filiaciones:
Crespo-Leiro, MG:
Univ A Coruna, Complejo Hosp Univ A Coruna, Inst Invest Biomed A Coruna INIBIC, Unidad Insuficiencia Cardiaca & Trasplante,Serv C, La Coruna, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Lopez-Vilella, R:
Hosp Univ & Politecn La Fe, Unidad Insuficiencia Cardiaca & Trasplante, Serv Cardiol, Valencia, Spain
Granados, AL:
Hosp Univ Reina Sofia, Unidad Trasplante Cardiaco, Cordoba, Spain
Mirabet-Perez, S:
Hosp Santa Creu & Sant Pau, Serv Cardiol, Unidad Insuficiencia Cardiaca, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Serv Cardiol, Programa Trasplante Cardiaco, Barcelona, Spain
Diez-Lopez, C:
Hosp Univ Bellvitge, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Barcelona, Spain
Barge-Caballero, E:
Univ A Coruna, Complejo Hosp Univ A Coruna, Inst Invest Biomed A Coruna INIBIC, Unidad Insuficiencia Cardiaca & Trasplante,Serv C, La Coruna, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Segovia-Cubero, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Univ Puerta de Hierro, Unidad Insuficiencia Cardiaca Trasplante Cardiaco, Madrid, Spain
Gonzalez-Vilchez, F:
Hosp Univ Marques de Valdecilla, Serv Cardiol, Santander, Spain
Rangel-Sousa, D:
Hosp Univ Virgen del Rocio, Serv Cardiol, Unidad Insuficiencia Cardiaca & Trasplante Cardia, Seville, Spain
Blasco-Peiro, T:
Hosp Univ Miguel Servet, Serv Cardiol, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Zaragoza, Spain
de la Fuente-Gal?n, L:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Clin Univ Valladolid, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Valladolid, Spain
Diaz-Molina, B:
Hosp Univ Cent Asturias, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Oviedo, Spain
Zatarain-Nicolas, E:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Gen Univ Gregorio Maranon, Serv Cardiol, Madrid, Spain
Avalos, FC:
Hosp Univ Reina Sofia, Unidad Trasplante Cardiaco, Cordoba, Spain
Almenar-Bonet, L:
Hosp Univ & Politecn La Fe, Unidad Insuficiencia Cardiaca & Trasplante, Serv Cardiol, Valencia, Spain
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