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Use of Idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. A multicentric experience in Spain.

Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade Da Coruña (UDC), A Coruña, Spain. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain. Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain. Unidad de Trasplante Cardíaco, Hospital Universitario Reina Sofía, Córdoba, Spain. Unidad de Insuficiencia Cardíaca y Programa de Trasplante Cardíaco, Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain. Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital Universitari de Bellvitge, Barcelona, Spain. Unidad de Insuficiencia Cardiaca Avanzada, Trasplante Cardiaco e Hipertensión Pulmonar, Hospital Universitario Puerta de Hierro, Madrid, Spain. Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Unidad de Insuficiencia Cardíaca y Trasplante Cardíaco, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain. Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital Universitario Central de Asturias, Oviedo, Spain. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Clinical transplantation. 2019;(12):e13748
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Abstract

BACKGROUND Anticoagulation in heart transplant (HT) recipients increases the risk of hemorrhagic complications, so correct reversal of anticoagulation is needed. Dabigatran, a direct thrombin inhibitor, is increasingly used for anticoagulation in patients with non-valvular atrial fibrillation (NVAF) whose effect can be reversed by idarucizumab. AIM: To present a nationwide experience using idarucizumab for the urgent reversal of dabigatran before HT. METHODS Multicenter observational study in 12 Spanish centers to analyze the clinical outcomes after using idarucizumab before HT surgery. RESULTS Fifty-three patients were included (81.1% male). 7.5% required re-operation in the immediate postoperative period to control bleeding and 66% transfusion of blood products. Median length of stay in the intensive care unit was 6 days and total hospital stay 24 days. 30-day survival was 92.4%. There were four deaths in the first month, all in the first 5 days post-HT. Only in one patient (transplanted due to a congenital heart disease, after sternotomy) who had surgical problems and right ventricular failure post-HT death was associated with bleeding. CONCLUSIONS These results may support the use of dabigatran as an alternative to vitamin K antagonists in patients listed for HT requiring anticoagulation due to NVAF. More studies are needed to reaffirm these observations.

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