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Use of idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. a multicentric experience in spain

Session Poster Session 1

Speaker Maria Generosa Crespo-Leiro

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Heart Transplantation
  • Session type : Poster Session

Authors : M G Crespo-Leiro (La Coruña,ES), RLV Raquel Lopez-Vilella (Valencia,ES), ALG Amador Lopez Granados (Cordoba,ES), S Mirabet-Perez (Barcelona,ES), C Diez-Lopez (Hospitalet De Llobregat,ES), E Barge-Caballero (La Coruña,ES), J Segovia-Cubero (Madrid,ES), F Gonzalez-Vilchez (Santander,ES), D Rangel-Sousa (Sevilla,ES), T Blasco-Peiro (Zaragoza,ES), L De La Fuente-Galan (Valladolid,ES), B Diaz-Molina (Oviedo,ES), E Zatarain-Nicolas (Madrid,ES), F Carrasco Avalos (Cordoba,ES), L Almenar-Bonet (Valencia,ES)

M G Crespo-Leiro1 , RLV Raquel Lopez-Vilella2 , ALG Amador Lopez Granados3 , S Mirabet-Perez4 , C Diez-Lopez5 , E Barge-Caballero1 , J Segovia-Cubero6 , F Gonzalez-Vilchez7 , D Rangel-Sousa8 , T Blasco-Peiro9 , L De La Fuente-Galan10 , B Diaz-Molina11 , E Zatarain-Nicolas12 , F Carrasco Avalos3 , L Almenar-Bonet2 , 1Hospital Universitario A Coruña - La Coruña - Spain , 2Hospital Universitario y Polit??cnico La Fe - Valencia - Spain , 3University Hospital Reina Sofia - Cordoba - Spain , 4Hospital de la Santa Creu i Sant Pau - Barcelona - Spain , 5University Hospital of Bellvitge - Barcelona - Spain , 6University Hospital Puerta de Hierro Majadahonda - Madrid - Spain , 7University Hospital Marques de Valdecilla - Santander - Spain , 8Hospital Universitario Virgen del Rocio - Sevilla - Spain , 9University Hospital Miguel Servet - Zaragoza - Spain , 10University Hospital Clinic of Valladolid - Valladolid - Spain , 11University Hospital Central de Asturias - Oviedo - Spain , 12University Hospital Gregorio Maranon - Madrid - Spain ,


INTRODUCTION AND OBJECTIVES: Anticoagulation in heart transplant (HT) recipients increases the risk of serious hemorrhagic complications during the perioperative period, so the urgent and correct reversal of anticoagulation is of great importance. Dabigatran, a direct thrombin inhibitor, is increasingly being used for anticoagulation in patients with non-valvular atrial fibrillation (NVAF) whose effect can be reversed by idarucizumab in situations where urgent surgery such as a HT may be needed. Aim: To present the preliminary experience of the use of idarucizumab for the urgent reversal of dabigatran in patients receiving a HT in Spain.
METHODS: Observational study, carried out in 12 adult HT Spanish centers to analyze the clinical outcomes of the use of Idarucizumab (5 mg) for urgent reversal of dabigatran effects at the HT surgery.
RESULTS: 53 patients were included, 81.1% male. One patient required a rescue dose. 7.5% required redo surgery in the immediate postoperative period to control bleeding and 66% needed transfusion of blood products. The average length of stay in the intensive care unit was 5 days and the total hospital stay was 23 days. The 30-day survival was 92.4% . There were 4 deaths during hospitalization, three of them in the first five days after HT. In 3 cases, death was not related to bleeding. In one case, a patient transplanted because a congenital heart disease with previous sternotomy, death occurred at 2 days post-HT associated to surgical problems, right ventricular failure, cardiac arrest and bleeding (bleeding ocurred 12 hours after HT surgery)
CONCLUSION: These results may support the use of dabigatran as an alternative to vitamin K antagonists in patients with HT who require anticoagulation for NVAF. More studies are needed to corroborate these observations.

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