Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jul;38(7):e15380.
doi: 10.1111/ctr.15380.

Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion

Maria Del Val Groba Marco  1   2 , Pedro Saavedra Santana  3 , Luz Maria Gonzalez Del Castillo  4 , Mario Galvan Ruiz  1 , Miguel de Fernandez de Sanmamed  1 , Stefano Urso  5 , Elisabet Guerra Hernández  6 , Laura Quintana Paris  4 , Michelle Tout Castellano  7   8 , Jose Luis Romero Lujan  8 , Eduardo Jose Caballero Dorta  1   2 , Luisa Maria Guerra Dominguez  4 , Antonio Garcia Quintana  1
Affiliations
Observational Study

Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion

Maria Del Val Groba Marco et al. Clin Transplant. 2024 Jul.

Abstract

Background: We aimed to evaluate the characteristics, clinical outcomes, and blood product transfusion (BPT) rates of patients undergoing cardiac transplant (CT) while receiving uninterrupted anticoagulation and antiplatelet therapy.

Methods: A retrospective, single-center, and observational study of adult patients who underwent CT was performed. Patients were classified into four groups: (1) patients without anticoagulation or antiplatelet therapy (control), (2) patients on antiplatelet therapy (AP), (3) patients on vitamin K antagonists (AVKs), and (4) patients on dabigatran (dabigatran). The primary endpoints were reoperation due to bleeding and perioperative BPT rates (packed red blood cells (PRBC), fresh frozen plasma, platelets). Secondary outcomes assessed included morbidity and mortality-related events.

Results: Of the 55 patients included, 6 (11%) received no therapy (control), 8 (15%) received antiplatelet therapy, 15 (27%) were on AVKs, and 26 (47%) were on dabigatran. There were no significant differences in the need for reoperation or other secondary morbidity-associated events. During surgery patients on dabigatran showed lower transfusion rates of PRBC (control 100%, AP 100%, AVKs 73%, dabigatran 50%, p = 0.011) and platelets (control 100%, AP 100%, AVKs 100%, dabigatran 69%, p = 0.019). The total intraoperative number of BPT was also the lowest in the dabigatran group (control 5.5 units, AP 5 units, AVKs 6 units, dabigatran 3 units; p = 0.038); receiving significantly less PRBC (control 2.5 units, AP 3 units, AVKs 2 units, dabigatran 0.5 units; p = 0.011). A Poisson multivariate analysis showed that only treatment on dabigatran reduces PRBC requirements during surgery, with an expected reduction of 64.5% (95% CI: 32.4%-81.4%).

Conclusions: In patients listed for CT requiring anticoagulation due to nonvalvular atrial fibrillation, the use of dabigatran and its reversal with idarucizumab significantly reduces intraoperative BPT demand.

Keywords: anticoagulation; antiplatelet therapy; cardiac transplant; dabigatran; idarucizumab; transfusion; vitamin k antagonists.

PubMed Disclaimer

References

    1. R. López‐Vilella, F. González‐Vílchez, M. G. Crespo‐Leiro, et al., “Impact of Donor‐Recipient Age on Cardiac Transplant Survival. Subanalysis of the Spanish Heart Transplant Registry,” Revista Española de Cardiología 74, no. 5 (2021): 393–401, https://doi.org/10.1016/j.rec.2020.02.016.
    1. M. R. Costanzo, A. Dipchand, R. Starling, et al., “The International Society of Heart and Lung Transplantation Guidelines for the Care of Heart Transplant Recipients,” Journal of Heart and Lung Transplantation 29, no. 8 (2010): 914–956, https://doi.org/10.1016/j.healun.2010.05.034.
    1. M. R. Wanek, K. Hodges, R. A. Persaud, et al., “Prothrombin Complex Concentrates for Warfarin Reversal Prior to Heart Transplantation,” Annals of Thoracic Surgery 107 (2019): 1409–1415, https://doi.org/10.1016/j.athoracsur.2018.10.032.
    1. G. Ramsey, “Blood Banking in Solid Organ Transplantation,” Annals of Blood 7 (2022): 15, https://dx.doi.org/10.21037/aob‐21‐72.
    1. K. Subramaniam, A. Kumar, S. Hernandez and S. M. Nouraie, “Effect of Blood Product Transfusion on Perioperative Outcomes After Heart Transplantation,” Journal of Cardiothoracic and Vascular Anesthesia 35, no. 4 (2021): 1067–1072, https://doi.org/10.1053/j.jvca.2020.10.024.

Publication types

LinkOut - more resources