Herrera-Escandón Álvaro, Castaño-Cifuentes Orlando, Plata-Mosquera Carlos A
Internal Medicine Department, Universidad del Valle, Cali, Colombia.
Cardiology Department, DIME Clínica Neurocardiovascular, Cali, Colombia.
Case Rep Cardiol. 2020 Mar 6;2020:6927423. doi: 10.1155/2020/6927423. eCollection 2020.
Heart transplant is a surgical procedure with a high risk of perioperative bleeding in patients with a previous history of sternotomy, congestive liver disease, and/or use of oral anticoagulants. Anticoagulation is usually done with coumarin agents (warfarin, acenocoumarol), while on the waiting list, vitamin K is available allowing for partial reversal of the anticoagulant effect, although with variable INR and risk of uncontrolled bleeding. Direct oral anticoagulants have emerged as an alternative to the use of coumarins in patients with nonvalvular atrial fibrillation (NVAF). The main disadvantage of this group of drugs is that there was no specific reversal agent available that would allow an urgent reversal of the anticoagulant effect. The recent commercialization of idarucizumab (specific reversal agent) has allowed patients with NVAF on the waiting list for heart transplant to be treated with dabigatran. We present the case of a patient with advanced chronic heart failure and NVAF anticoagulated with dabigatran, who underwent urgent heart transplant after administration of idarucizumab, without complications derived from its use or from anticoagulation.
心脏移植是一种外科手术，对于有胸骨切开术史、充血性肝病和/或使用口服抗凝剂的患者，围手术期出血风险很高。在等待名单上时，抗凝通常使用香豆素类药物（华法林、醋硝香豆素），维生素K可用于部分逆转抗凝作用，尽管国际标准化比值（INR）会有所变化且存在出血失控风险。直接口服抗凝剂已成为非瓣膜性心房颤动（NVAF）患者使用香豆素类药物的替代选择。这类药物的主要缺点是没有可用的特异性逆转剂来紧急逆转抗凝作用。达比加群酯特异性逆转剂艾达赛珠单抗最近商业化，使得等待心脏移植的NVAF患者能够使用达比加群酯进行治疗。我们报告了一例晚期慢性心力衰竭合并NVAF且使用达比加群酯抗凝的患者，在使用艾达赛珠单抗后接受了紧急心脏移植，未出现因使用该药或抗凝导致的并发症。
