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Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product
Maria Del Val Groba Marco1,2, Pedro Saavedra Santana3, Luz Maria Gonzalez Del Castillo4
1Cardiology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Insights
Dabigatran use in cardiac transplant patients significantly reduced the need for blood product transfusions, particularly packed red blood cells, during surgery. This finding supports dabigatran as a safe and effective anticoagulation option in this population.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pharmacology
Background:
- Cardiac transplant (CT) patients often require anticoagulation and antiplatelet therapy.
- Evaluating the impact of uninterrupted therapy on clinical outcomes and blood product transfusion (BPT) is crucial.
Purpose of the Study:
- To assess the characteristics, clinical outcomes, and BPT rates in CT patients on uninterrupted anticoagulation/antiplatelet therapy.
- To compare outcomes among patients receiving no therapy, antiplatelet therapy, vitamin K antagonists (AVKs), or dabigatran.
Main Methods:
- Retrospective, single-center, observational study of adult CT patients.
- Classification into four groups: control, antiplatelet (AP), AVK, and dabigatran.
- Primary endpoints: reoperation for bleeding and perioperative BPT (packed red blood cells (PRBC), fresh frozen plasma, platelets).
Main Results:
- Dabigatran group showed significantly lower transfusion rates for PRBC (50%) and platelets (69%) compared to control (100%) and AVK (73% PRBC, 100% platelets).
- Total intraoperative BPT was lowest in the dabigatran group (3 units).
- Multivariate analysis indicated dabigatran use reduced PRBC requirements by 64.5%.
Conclusions:
- Uninterrupted dabigatran therapy, with idarucizumab reversal, significantly decreases intraoperative blood product transfusion demand in cardiac transplant patients.
- Dabigatran is a viable anticoagulation option for CT patients with nonvalvular atrial fibrillation.
Background:
We aimed to evaluate the characteristics, clinical outcomes, and blood product transfusion (BPT) rates of patients undergoing cardiac transplant (CT) while receiving uninterrupted anticoagulation and antiplatelet therapy.
Methods:
A retrospective, single-center, and observational study of adult patients who underwent CT was performed. Patients were classified into four groups: (1) patients without anticoagulation or antiplatelet therapy (control), (2) patients on antiplatelet therapy (AP), (3) patients on vitamin K antagonists (AVKs), and (4) patients on dabigatran (dabigatran). The primary endpoints were reoperation due to bleeding and perioperative BPT rates (packed red blood cells (PRBC), fresh frozen plasma, platelets). Secondary outcomes assessed included morbidity and mortality-related events.
Results:
Of the 55 patients included, 6 (11%) received no therapy (control), 8 (15%) received antiplatelet therapy, 15 (27%) were on AVKs, and 26 (47%) were on dabigatran. There were no significant differences in the need for reoperation or other secondary morbidity-associated events. During surgery patients on dabigatran showed lower transfusion rates of PRBC (control 100%, AP 100%, AVKs 73%, dabigatran 50%, p = 0.011) and platelets (control 100%, AP 100%, AVKs 100%, dabigatran 69%, p = 0.019). The total intraoperative number of BPT was also the lowest in the dabigatran group (control 5.5 units, AP 5 units, AVKs 6 units, dabigatran 3 units; p = 0.038); receiving significantly less PRBC (control 2.5 units, AP 3 units, AVKs 2 units, dabigatran 0.5 units; p = 0.011). A Poisson multivariate analysis showed that only treatment on dabigatran reduces PRBC requirements during surgery, with an expected reduction of 64.5% (95% CI: 32.4%-81.4%).
Conclusions:
In patients listed for CT requiring anticoagulation due to nonvalvular atrial fibrillation, the use of dabigatran and its reversal with idarucizumab significantly reduces intraoperative BPT demand.
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