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Perioperative Myocardial Infarction Following Dabigatran Reversal With Idarucizumab in a Patient Undergoing
Alex Barroso1, M Carmen Martinez-Gonzalez2, Nathanael Knowlson1
1Anesthesiology and Reanimation, Hospital Regional Universitario de Málaga, Málaga, ESP.
Insights
Direct oral anticoagulants like dabigatran are used in cirrhosis patients awaiting liver transplant. Idarucizumab reversal before transplant in this case was followed by myocardial infarction, suggesting a potential link.
Area of Science:
- Hepatology
- Cardiology
- Anesthesiology
Background:
- Limited data exists on direct oral anticoagulant (DOAC) use in liver transplant candidates.
- Cirrhosis patients often require anticoagulation for conditions like atrial fibrillation.
- Managing anticoagulation and its reversal in this high-risk population is challenging.
Abstract:
Insufficient information is available regarding the administration of anticoagulants, specifically direct oral anticoagulants, in individuals with cirrhosis awaiting liver transplantation. In this report, we present a case of a 66-year-old male with atrial fibrillation treated with dabigatran who received idarucizumab prior to orthotopic liver transplantation. Hemostatic status was monitored throughout the procedure with both conventional hemostatic tests and point-of-care viscoelastic hemostatic assays. The patient suffered an intraoperative myocardial infarction, which could be related to the use of idarucizumab.
