背景:我们旨在评估特征,临床结果,接受不间断抗凝和抗血小板治疗的心脏移植(CT)患者的血制品输血(BPT)率。
方法:回顾性研究,单中心,并对接受CT的成年患者进行了观察性研究。患者分为四组:(1)未接受抗凝治疗或抗血小板治疗的患者(对照组),(2)接受抗血小板治疗(AP)的患者,(3)患者对维生素K拮抗剂(AVKs)、和(4)达比加群(dabigatran)的患者。主要终点是由于出血和围手术期BPT率而再次手术(浓缩红细胞(PRBC),新鲜冷冻血浆,血小板)。评估的次要结局包括发病率和死亡率相关事件。
结果:在55名患者中,6人(11%)未接受治疗(对照),8人(15%)接受抗血小板治疗,15人(27%)在AVK上,26人(47%)服用达比加群。需要再次手术或其他继发发病相关事件没有显着差异。在手术期间,达比加群患者的PRBC输血率较低(对照组为100%,AP100%,AVKs73%,达比加群50%,p=0.011)和血小板(对照100%,AP100%,AVKs100%,达比加群69%,p=0.019)。术中BPT总数在达比加群组中也是最低的(对照5.5个单位,AP5个单位,AVKs6个单位,达比加群3个单位;p=0.038);接收显著较少的PRBC(对照2.5个单位,AP3个单位,AVKs2个单位,达比加群0.5单位;p=0.011)。泊松多变量分析显示,只有达比加群的治疗才能降低手术期间的PRBC需求,预期减少64.5%(95%CI:32.4%-81.4%)。
结论:在非瓣膜性心房颤动需要抗凝治疗的CT患者中,达比加群的使用及其与idarucizumab的逆转显著降低了术中BPT的需求.
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.