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在一名接受原位肝移植的患者中，使用艾达赛珠单抗逆转达比加群后发生围手术期心肌梗死

Perioperative Myocardial Infarction Following Dabigatran Reversal With Idarucizumab in a Patient Undergoing Orthotopic Liver Transplantation.

作者信息

Barroso Alex, Martinez-Gonzalez M Carmen, Knowlson Nathanael, Miguel Alba M, Perez Gonzalo

机构信息

Anesthesiology and Reanimation, Hospital Regional Universitario de Málaga, Málaga, ESP.

Intensive Care Unit, Hospital Regional Universitario de Málaga, Málaga, ESP.

出版信息

Cureus. 2023 Aug 15;15(8):e43531. doi: 10.7759/cureus.43531. eCollection 2023 Aug.

DOI:10.7759/cureus.43531
PMID:37719481
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10503784/
Abstract

Insufficient information is available regarding the administration of anticoagulants, specifically direct oral anticoagulants, in individuals with cirrhosis awaiting liver transplantation. In this report, we present a case of a 66-year-old male with atrial fibrillation treated with dabigatran who received idarucizumab prior to orthotopic liver transplantation. Hemostatic status was monitored throughout the procedure with both conventional hemostatic tests and point-of-care viscoelastic hemostatic assays. The patient suffered an intraoperative myocardial infarction, which could be related to the use of idarucizumab.

摘要

关于在等待肝移植的肝硬化患者中使用抗凝剂，特别是直接口服抗凝剂的信息不足。在本报告中，我们介绍了一例66岁患有心房颤动的男性患者，该患者接受达比加群治疗，并在原位肝移植前接受了依达赛珠单抗治疗。在整个手术过程中，通过传统的止血测试和即时粘弹性止血分析来监测止血状态。该患者术中发生心肌梗死，这可能与依达赛珠单抗的使用有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/c99c604981bc/cureus-0015-00000043531-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/b84c02961377/cureus-0015-00000043531-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/1679f1ed3f48/cureus-0015-00000043531-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/674a2c581d50/cureus-0015-00000043531-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/10949ba18bba/cureus-0015-00000043531-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/c99c604981bc/cureus-0015-00000043531-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/b84c02961377/cureus-0015-00000043531-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/1679f1ed3f48/cureus-0015-00000043531-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/674a2c581d50/cureus-0015-00000043531-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/10949ba18bba/cureus-0015-00000043531-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e0a/10503784/c99c604981bc/cureus-0015-00000043531-i05.jpg

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本文引用的文献

1
Viscoelastic hemostatic assays: Update on technology and clinical applications.黏弹止血检测：技术和临床应用的更新。
Am J Hematol. 2021 Oct 1;96(10):1331-1337. doi: 10.1002/ajh.26285. Epub 2021 Jul 16.
2
Dabigatran Reversal With Idarucizumab in 2 Patients With Portal Vein Thrombosis Undergoing Orthotopic Liver Transplantation.两名门静脉血栓形成患者行原位肝移植时应用依达鲁珠单抗逆转达比加群。
Semin Cardiothorac Vasc Anesth. 2021 Sep;25(3):200-207. doi: 10.1177/1089253220982183. Epub 2021 Jan 4.
3
The incidence of thrombotic events with idarucizumab and andexanet alfa: A systematic review and meta-analysis.
依达鲁单抗和andexanet alfa 导致血栓事件的发生率：系统评价和荟萃分析。
Thromb Res. 2020 Dec;196:291-296. doi: 10.1016/j.thromres.2020.09.003. Epub 2020 Sep 3.
4
Non-Vitamin K Antagonist Oral Anticoagulants and Risk of Serious Liver Injury.非维生素 K 拮抗剂口服抗凝剂与严重肝损伤风险。
J Am Coll Cardiol. 2018 Mar 13;71(10):1105-1113. doi: 10.1016/j.jacc.2018.01.009.
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Viscoelastic Testing in Liver Disease.肝脏疾病中的黏弹性测试。
Ann Hepatol. 2018 Mar 1;17(2):205-213. doi: 10.5604/01.3001.0010.8635.
6
Idarucizumab for Dabigatran Reversal - Full Cohort Analysis.达比加群酯逆转剂依达鲁珠单抗：全队列分析。
N Engl J Med. 2017 Aug 3;377(5):431-441. doi: 10.1056/NEJMoa1707278. Epub 2017 Jul 11.
7
Liver Cirrhosis in Patients With Atrial Fibrillation: Would Oral Anticoagulation Have a Net Clinical Benefit for Stroke Prevention?心房颤动患者的肝硬化：口服抗凝药对预防中风有净临床益处吗？
J Am Heart Assoc. 2017 Jun 23;6(6):e005307. doi: 10.1161/JAHA.116.005307.
8
Reversal of direct oral anticoagulants for liver transplantation in cirrhosis: A step forward.肝硬化患者肝移植中直接口服抗凝剂的逆转：向前迈进的一步。
Liver Transpl. 2017 Mar;23(3):396-397. doi: 10.1002/lt.24708.
9
Nonalcoholic fatty liver disease and the risk of clinical cardiovascular events: A systematic review and meta-analysis.非酒精性脂肪性肝病与临床心血管事件风险：一项系统评价和荟萃分析。
Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S209-S216. doi: 10.1016/j.dsx.2016.12.033. Epub 2016 Dec 15.
10
The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis.直接口服抗凝剂与传统抗凝剂在肝硬化患者中的疗效和安全性比较
Eur J Haematol. 2017 Apr;98(4):393-397. doi: 10.1111/ejh.12844. Epub 2017 Jan 15.