Cardiology Letters 2018, 27(5):238-241

Idarucizumab for urgent reversal of dabigatran before orthotopic heart transplantation

Danková M¹, Lesný P¹, Luknár M¹, Lauko V², Gonçalvesová E¹

¹ Oddelenia zlyhávania a transplantácie srdca, Národný ústav srdcových a cievnych chorôb, a.s., Bratislava

² Pracoviska hematológie a transfuzio­ lógie, Národný ústav srdcových a cievnych chorôb, a.s., Bratislava, Slovenská republika

Background: The use of dabigatran in patients with atrial fibrillation enlisted for heart transplantation has been limited by unpredictable timing of surgery and high bleeding risk. Case presentation: A 58-year-old male patient on dabigatran for atrial fibrillation was enlisted for heart transplantation due to advanced heart failure. Upon notification of a suitable heart donor, we prepared the patient for surgery. The last dose of dabigatran was 16 hours prior to the haemocoagulation blood tests. We recorded prolonged activated partial thromboplastin time (APTT), thrombin time (TT) and confirmed the presence of dabigatran at 31,3ng/ml. Before general anesthesia and extracorporeal circulation we received two boluses of 2.5 mg idarucizumab. Surgery and postoperative period were without complications.

Conclusions: Idarucizumab was associated with an affective hemostasis in the setting of heart transplantation, which allows the use of dabigatran in patients with atrial fibrillation on the heart transplant waiting list.

Keywords: dabigatran; idarucizumab; heart transplantation

Published: May 1, 2018  Show citation