Cardiology

Use of Idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. A multicentric experience in Spain.

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Use of Idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. A multicentric experience in Spain.

Clin Transplant. 2019 Oct 31;:

Authors: Crespo-Leiro MG, López-Vilella R, López Granados A, Mirabet-Pérez S, Díez-López C, Barge-Caballero E, Segovia-Cubero J, González-Vilchez F, Rangel-Sousa D, Blasco-Peiró T, de la Fuente-Galán L, Díaz-Molina B, Zatarain-Nicolás E, Carrasco Ávalos F, Almenar-Bonet L

Abstract
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: 53 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 4 deaths in the first month, all in the first five 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, was death associated to 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.

PMID: 31670852 [PubMed – as supplied by publisher]

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