Jóźwik Agnieszka, Lisik Wojciech, Czerwiński Jarosław, Kosieradzki Maciej
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of General and Transplantation Surgery , Medical University of Warsaw, Warsaw, Poland.
Ann Transplant. 2018 Apr 6;23:232-235. doi: 10.12659/AOT.905868.
BACKGROUND New oral anticoagulants like direct thrombin inhibitors are an attractive alternative to vitamin K antagonists as anticoagulation therapy and can be used in heparin-induced thrombocytopenia. They are convenient in low-risk surgery, as there is no need for bridging with heparins. Patients who need urgent major surgery are at similar risk as on warfarin therapy, which, however, is much higher than in elective procedures. Due to their elimination profiles, these drugs are generally contraindicated in patients with severe renal insufficiency. On the other hand, pancreas transplantation is associated with high risk of bleeding and substantial risk of graft thrombosis. There are no recommendations on anticoagulation therapy in high-risk patients on kidney-pancreas waiting lists who cannot be given heparins. CASE REPORT We describe a case of simultaneous pancreas-kidney transplantation in a patient with heparin-induced thrombocytopenia on dabigatran treatment. CONCLUSIONS We conclude that, despite the high risk, pancreas transplantation in a patient with HIT can be safely done while on NOAC therapy, but an access to idarucizumab should be assured.
新型口服抗凝药如直接凝血酶抑制剂作为抗凝治疗手段，是维生素K拮抗剂颇具吸引力的替代选择，可用于肝素诱导的血小板减少症。在低风险手术中使用很方便，因为无需与肝素桥接。需要紧急进行大手术的患者与接受华法林治疗时的风险相似，但这一风险在择期手术中要高得多。由于这些药物的消除情况，严重肾功能不全患者通常禁用。另一方面，胰腺移植有出血风险高和移植血栓形成的重大风险。对于不能使用肝素的肾胰腺等待名单上的高危患者，尚无抗凝治疗的建议。病例报告：我们描述了1例正在接受达比加群治疗且患有肝素诱导的血小板减少症的患者同时进行胰肾移植的病例。结论：我们得出结论，尽管风险很高，但在接受非维生素K口服抗凝药（NOAC）治疗的肝素诱导的血小板减少症（HIT）患者中，胰腺移植仍可安全进行，但应确保能获得依达赛珠单抗。
