Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Pharmacy, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA, USA.
Clin Transplant. 2021 Jan;35(1):e14142. doi: 10.1111/ctr.14142. Epub 2020 Nov 19.
When the transplant candidates are receiving oral anticoagulation therapy before transplantation, it is crucial to have an urgent reversal strategy to prevent hemorrhagic complications perioperatively. The aim of this study was to present the experience with idarucizumab to reverse the anticoagulant activity of dabigatran prior to lung transplantation.
A single-center retrospective study was performed to analyze the clinical outcomes of idarucizumab use before lung transplantation.
Between July 2016 and June 2019, six patients were on dabigatran at the time of transplantation. Out of the six patients, four patients received idarucizumab. These four recipients received a median of 3 units (range 0-4 units) of packed red blood cells (pRBCs) and 450 ml (range 250-1500 ml) of intraoperative salvage of shed blood (cell saver blood) during the lung transplant. The two patients who were not administered idarucizumab received 5 units and 13 units of pRBCs and 900 ml and 3600 ml of cell saver blood, respectively. There was no grade 3 primary graft dysfunction (PGD) at 72 hours after transplantation or in-hospital mortality in idarucizumab group. In the group without idarucizumab, there was one case of grade 3 PGD without any in-hospital mortality.
Dabigatran reversal with idarucizumab provides reasonable hemostasis during lung transplantation.
当移植候选者在移植前接受口服抗凝治疗时，拥有紧急逆转策略以预防围手术期出血并发症至关重要。本研究旨在介绍在肺移植前使用依达鲁单抗逆转达比加群抗凝作用的经验。
进行了一项单中心回顾性研究，以分析肺移植前使用依达鲁单抗的临床结果。
2016 年 7 月至 2019 年 6 月期间，有 6 名患者在移植时接受达比加群治疗。这 6 名患者中有 4 名接受了依达鲁单抗。这 4 名接受者在肺移植期间平均接受了 3 单位（范围 0-4 单位）的浓缩红细胞（pRBC）和 450ml（范围 250-1500ml）的术中回收失血（细胞保存血）。未接受依达鲁单抗治疗的 2 名患者分别接受了 5 单位和 13 单位的 pRBC 和 900ml 和 3600ml 的细胞保存血。在依达鲁单抗组中，移植后 72 小时或住院期间没有 3 级原发性移植物功能障碍（PGD）或死亡。在未使用依达鲁单抗的组中，有 1 例 3 级 PGD，无任何住院死亡。
达比加群逆转剂依达鲁单抗在肺移植期间提供了合理的止血效果。
