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Ischemic Heart Disease in Liver Transplant Candidates With High Bleeding Risk: Any Way Out?
Chiara Del Carlo1, Lorenza Santoni1, Iacopo Fabiani2
1Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Insights
Managing coronary artery disease (CAD) in liver transplant candidates is complex. Careful balancing of bleeding and clotting risks is essential for successful outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) management poses challenges in liver transplant candidates due to dual risks of bleeding and thrombosis.
- Antiplatelet therapy, crucial for preventing thrombotic events, can elevate hemorrhagic risks during hepatic surgery.
Observation:
- A 71-year-old woman with end-stage liver disease (ESLD) presented with significant CAD requiring pretransplantation evaluation.
- A multidisciplinary team opted for invasive CAD treatment, implementing precautions to mitigate bleeding risks.
Findings:
- Managing CAD in ESLD patients is intricate due to complex comorbidities and high perioperative risks.
- Active screening for CAD in ESLD patients awaiting liver transplantation is recommended.
Implications:
- Further research is needed to establish optimal CAD treatment strategies for this specific patient population.
- Multidisciplinary care is vital for optimizing outcomes in liver transplant candidates with CAD.
Abstract:
Coronary artery disease in candidates for liver transplantation is a real challenge because of the need to balance the risks of bleeding and thrombosis. Antiplatelet therapy, essential to prevent thrombotic events, may increase the risk of hemorrhagic complications, especially in the context of hepatic surgery. A 71-year-old woman with end-stage liver disease (ESLD) presented for a pretransplantation evaluation. She received a diagnosis of significant coronary artery disease (CAD), and a multidisciplinary discussion resulted in the option for an invasive treatment with several precautions to minimize her bleeding risk. Because of the intricacy of underlying comorbidities and the elevated perioperative risk, managing CAD in patients with ESLD is particularly challenging. More research and evidence are needed on treating CAD in this patient group. Patients with ESLD who are waiting for liver transplantation should have CAD actively screened. Multidisciplinary treatment is crucial to maximizing the results.
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