University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Semin Cardiothorac Vasc Anesth. 2021 Sep;25(3):200-207. doi: 10.1177/1089253220982183. Epub 2021 Jan 4.
There are limited data to guide the use of anticoagulation in cirrhotic patients prior to liver transplantation especially when using direct oral anticoagulants. In this article, we present 2 cases. The first is a 42-year-old male with cirrhosis complicated by portal vein thrombosis (PVT) treated with dabigatran who underwent orthotopic liver transplantation without complication. The second case is a 65-year-old man with alcoholic cirrhosis complicated by PVT treated with dabigatran who underwent orthotopic liver transplantation and required reoperation for surgical bleeding. Both patients were treated with dabigatran's reversal agent idarucizumab prior to incision. In this case series, we discuss the treatment of cirrhotic patients with various anticoagulants, considerations for anticoagulant selection and reversal prior to liver transplant, and questions for future investigation.
在肝移植前，针对肝硬化患者使用抗凝药物（尤其是直接口服抗凝剂）的问题，目前仅有有限的数据可以参考。本文报告了 2 例病例。第一例为 42 岁男性，患有肝硬化合并门静脉血栓形成（PVT），接受达比加群治疗，未发生并发症，顺利接受原位肝移植。第二例为 65 岁男性，患有酒精性肝硬化合并 PVT，接受达比加群治疗，在接受原位肝移植后因手术出血需要再次手术。在切开前，两名患者均使用了达比加群拮抗剂依达鲁单抗进行治疗。在本病例系列中，我们讨论了使用各种抗凝药物治疗肝硬化患者的问题，以及在肝移植前抗凝药物选择和逆转的注意事项，还提出了一些未来研究的问题。
