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Idarucizumab for urgent dabigatran reversal at the heart transplantation surgery. Multicenter experience from Spain

Session Poster Session 2

Speaker Maria Generosa Crespo-Leiro

Event : Heart Failure 2018

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Cardiovascular Surgery - Other
  • Session type : Poster Session

Authors : M G Crespo-Leiro (La Coruña,ES), F Carrasco-Avalos (Cordoba,ES), S Mirabet-Perez (Barcelona,ES), T Blasco-Peiro (Zaragoza,ES), D Rangel-Sousa (Seville,ES), F Gonzalez-Vilchez (Santander,ES), E Barge-Caballero (La Coruña,ES), A Lopez-Granados (Cordoba,ES), E Roig (Barcelona,ES), A Portoles-Ocampo (Zaragoza,ES), A Grande-Trillo (Seville,ES), JA Vazquez-De-Prada (Santander,ES), V Brossa (Barcelona,ES), JM Arizon-Del-Prado (Cordoba,ES)

Authors:
M G Crespo-Leiro1 , F Carrasco-Avalos2 , S Mirabet-Perez3 , T Blasco-Peiro4 , D Rangel-Sousa5 , F Gonzalez-Vilchez6 , E Barge-Caballero1 , A Lopez-Granados2 , E Roig3 , A Portoles-Ocampo4 , A Grande-Trillo5 , JA Vazquez-De-Prada6 , V Brossa3 , JM Arizon-Del-Prado2 , 1Hospital Universitario A Coruña - La Coruña - Spain , 2University Hospital Reina Sofia - Cordoba - Spain , 3Hospital de la Santa Creu i Sant Pau - Barcelona - Spain , 4University Hospital Miguel Servet - Zaragoza - Spain , 5University Hospital of Virgen del Rocio - Seville - Spain , 6University Hospital Marques de Valdecilla - Santander - Spain ,

Citation:

Anticoagulation in heart transplant (HT) recipients increases the risk of serious hemorrhagic complications during the perioperative period therefore urgent anticoagulation reversion is a challenge. Dabigatran is a direct thrombin inhibitor incresingly used for anticoagulation in patients with heart failure and atrial fibrilation. Idarucizumab is the first targeted reversal agent available and is specific for dabigatran. In emergency situations like threatening bleeding or urgent surgery, idarucizumab promptly, durably, and safely reversed the anticoagulant effect of dabigatran. The usefulness of idarucizumab for dabigatran reversal at the HT surgery is not well known.  

AIM: To present preliminary experience of idarucizumab use for dabigatran reveral in patients undergoing HT.

Methods: Observational multicenter study of using idarucizumab for urgent dabigatran reversal at the HT surgery in 6 HT Spanish centres from August 2016 to November 2017.  The following variables were collected to assess effectiveness and safety: recipient’s characteristics, Idarucizumab dose, need for redo in the immediate postoperative period to control bleeding, blood products transfusions, intensive care unit (ICU) and total hospitalization stay and survival.

Results: 11 patients from 6 centers, mean age 54.6 years, 7 males (63.6%) were treated with idarucizumab for dabigatran reversal at HT surgery. Etiology of heart disease: 7 non-ischemic dilated cardiomyopathy (63.6%), 3 hypertrophic cardiomyopathy (27.2%) and 1 other (9.1%). None of the cases had a prior sternotomy. Idarucizumab dose was 5 mg (2,5 mg x 2) in all cases and none of the patients needed rescue doses for bleeding control. Redo for bleeding control was needed in 3 (27.2%) patients. 7 (63.6%) patients required blood products transfusions: plasma 4 patients (mean 1312,5 cc), packed red blood cells 6 patients (mean 4.5 units) and platelets 4 patients (mean 2.25 platelets pools. Mean ICU stay was 10.5 days and mean hospital stay was 33.9 days. There was only one intrahospital death at 47th day after HT due to multiorgan failure and infectious complications but not considered related to bleeding. 

Conclusions: This preliminary experience with the use of idarucizumab (5 mg) for urgent reversion of dabigatran at HT surgery is encouraging. Although one third of patients required early redo due to bleeding complications and 2/3 transfusions, no perioperative early mortality was appreciated. These results may support the use of dabigatran as an alternative to vitamin K antagonists in HT candidates that require anticoagulation. More studies are needed to corroborate these observations.

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