Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-01 DOI:10.1111/ctr.15380

Maria del Val Groba Marco, Pedro Saavedra Santana, Luz Maria Gonzalez del Castillo, Mario Galvan Ruiz, Miguel de Fernandez de Sanmamed, Stefano Urso, Elisabet Guerra Hernández, Laura Quintana Paris, Michelle Tout Castellano, Jose Luis Romero Lujan, Eduardo Jose Caballero Dorta, Luisa Maria Guerra Dominguez, Antonio Garcia Quintana

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引用次数: 0

Abstract

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.

Abstract Image

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心脏移植中的抗凝和抗血小板方案。临床特征、疗效和血制品输注。

背景：我们旨在评估心脏移植（CT）患者在接受不间断抗凝和抗血小板治疗期间的特征、临床结果和血液制品输注率：我们旨在评估不间断接受抗凝和抗血小板治疗的心脏移植（CT）患者的特征、临床结果和血液制品输注（BPT）率：对接受 CT 的成年患者进行了一项回顾性、单中心和观察性研究。患者分为四组：(1) 未接受抗凝或抗血小板治疗的患者（对照组）；(2) 接受抗血小板治疗的患者（AP 组）；(3) 接受维生素 K 拮抗剂治疗的患者（AVK 组）；(4) 接受达比加群治疗的患者（达比加群组）。主要终点是出血导致的再手术和围手术期BPT率（包装红细胞（PRBC）、新鲜冰冻血浆、血小板）。次要评估结果包括发病率和死亡率相关事件：在纳入的 55 例患者中，6 例（11%）未接受治疗（对照组），8 例（15%）接受了抗血小板治疗，15 例（27%）使用了 AVKs，26 例（47%）使用了达比加群。在再次手术需求或其他继发性发病相关事件方面没有明显差异。手术期间，服用达比加群的患者输注 PRBC（对照组 100%，AP 100%，AVKs 73%，达比加群 50%，P = 0.011）和血小板（对照组 100%，AP 100%，AVKs 100%，达比加群 69%，P = 0.019）的比例较低。达比加群组术中 BPT 的总数量也最少（对照组 5.5 个单位，AP 5 个单位，AVKs 6 个单位，达比加群 3 个单位；p = 0.038）；接受的 PRBC 明显较少（对照组 2.5 个单位，AP 3 个单位，AVKs 2 个单位，达比加群 0.5 个单位；p = 0.011）。泊松多变量分析显示，只有达比加群能减少手术期间的 PRBC 需求，预计减少率为 64.5%（95% CI：32.4%-81.4%）：结论：对于因非瓣膜性心房颤动而需要抗凝治疗的 CT 患者，使用达比加群及伊达珠单抗逆转可显著减少术中 BPT 需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.