Efficacy and Safety of Idarucizumab for Rapid Reversal from Dabigatran in Patients Undergoing Orthotopic Heart Transplantation

Abstract

Purpose To evaluate the effectiveness and safety of idarucizumab before urgent heart transplantation (HTPL) in patients using dabigatran. Methods Between March 2017 and January 2018, consecutive patients who underwent HTPL were evaluated at a single tertiary university hospital. Total 17 HTPL recipients were included in the present study. Patients were grouped into no-anticoagulation therapy (9 patients; Group 1), extracorporeal membrane oxygenator with heparin therapy (3 patients; Group 2), and dabigatran for stroke prevention in atrial fibrillation with idarucizumab reversal before HTPL surgery (5 patients; Group 3). Surgery time (pump time, and total surgery time), amount of packed red blood cell transfusion during surgery, and composite events (bleeding complications, stroke, venous thrombosis, death) during perioperative period were evaluated among three groups. Results Mean age of recipients was (51.2 ± 16.1 years, male 52.9%). Surgery time was longest in group 2 (Total surgery time: 328.3 ± 55.8, 336.4 ± 43.0, 288.8 ± 38.7; pump time 159.0 ± 21.7, 161.9 ± 27.2, 127.0 ± 17.9). Packed RBC transfusion volume was also higher in group 2 (133.3 ± 230.9, 511.1 ± 105.4, 40.0 ± 89.4). When compared with group 2, pump time was significantly shorter (p=0.028) and amount of PC transfusion was significantly lower (p=0.002) in group 3 (figure 1). Amount of transfusion was highest in group 2. Composite events were developed in only group 2 (four patients: vaginal bleeding 1; embolic cerebral infarction 1; venous thrombosis 1; non-cardiac death 1). Conclusion In terms of effectiveness and safety, using idarucizumab before HTPL was beneficial compared with heparin use during ECMO and comparable with non-anticoagulation, non-antiplatelet patients. Candidates for HTPL who are indicated for anticoagulation therapy may consider dabigatran with idarucizumab.