Bleeding Risk of Anticoagulation Reversal Strategies Before Heart Transplantation: A Retrospective Comparative Cohort...

Area of Science:

• Cardiology
• Transplantation Medicine
• Pharmacology

Background:

• Heart transplantation (HT) carries significant bleeding risks, particularly for patients requiring anticoagulation.
• Reversal of anticoagulation is critical in managing bleeding complications post-HT.
• Vitamin K antagonists (VKAs) are traditional reversal agents, but newer options exist.

Purpose of the Study:

• To evaluate idarucizumab for dabigatran (DBG) reversal versus VKA strategies in heart transplant recipients.
• To compare transfusion requirements, re-surgery rates, ICU length of stay, and 30-day survival.
• To analyze the cost-effectiveness of idarucizumab compared to VKA reversal.

Main Methods:

• Retrospective analysis of 34 heart transplant patients from January 2018 to December 2022.
• Exclusion of patients requiring immediate pre- or post-operative ECMO.
• Comparison of outcomes between patients on dabigatran reversed with idarucizumab and those on VKAs or not anticoagulated.

Main Results:

• Idarucizumab significantly reduced the need for transfusions (p = 0.034) and shortened ICU stays (p = 0.014).
• No significant differences were observed in re-surgery rates (p = 0.259) or 30-day survival (p = 0.955).
• Despite higher initial drug cost, idarucizumab reversal was comparable in overall cost due to reduced complications.

Conclusions:

• Idarucizumab is a viable anticoagulation reversal option for heart transplant patients on dabigatran.
• It offers comparable overall costs to VKA reversal, driven by decreased transfusion needs and shorter ICU stays.
• Further prospective studies are warranted to confirm these findings in larger patient cohorts.