PMID- 30153198
OWN - NLM
STAT- MEDLINE
DCOM- 20200512
LR  - 20200512
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 65
IP  - 7
DP  - 2019 Sep/Oct
TI  - Anticoagulation Reversal and Risk of Thromboembolic Events Among Heart Transplant 
      Recipients Bridged with Durable Mechanical Circulatory Support Devices.
PG  - 649-655
LID - 10.1097/MAT.0000000000000866 [doi]
AB  - Anticoagulation reversal agents (ARAs) can minimize bleeding complications 
      associated with mechanical circulatory support devices (MCSDs) explantation at 
      the time of heart transplantation (HT); data on thromboembolic (TE) risk 
      associated with ARAs are limited in this patient population. In this 
      single-center study, we retrospectively analyzed 118 consecutive adults who were 
      supported with durable MCSDs and underwent HT between May 2013 and October 2016. 
      Patients were categorized based on intraoperative use of ARAs (recombinant factor 
      VIIa [n=23], 4-factor prothrombin complex concentrate [n=48], or factor IX 
      complex [n=2]) at the time of HT; these agents were used at discretion of 
      implanting surgeons for bleeding control. The primary outcome of interest was 
      presence of venous or systemic TE events within 3 months of HT. Multivariable 
      logistic regression analyses were used to assess association between TE events 
      and use of ARAs. A total of 71 (60%) patients received ARAs, and a total of 32 
      patients (27.1%) had TE events (25 venous [median time to diagnosis: 11.5 days; 
      interquartile range IQR: 9-31 days], and 10 systemic [median time to diagnosis: 
      5.5 days; IQR: 4-8 days]); 26 (81.2%) of those with TE events had ARAs used at 
      the time of HT. Multivariable analysis identified use of ARAs as an independent 
      predictor of TE events (multivariable odds ratio: 3.06; 95% CI: 1.09-8.58; p = 
      0.034). Unplanned intraoperative use of ARAs to control bleeding was associated 
      with a significantly higher risk of TE events among HT recipients bridged with 
      durable MCSD. Future studies are required to further assess safety of these 
      agents and their impact on patient outcomes.
FAU - Moretz, Jeremy
AU  - Moretz J
AD  - From the Division of Heart Failure and Transplantation.
FAU - Lindenfeld, Joann
AU  - Lindenfeld J
AD  - From the Division of Heart Failure and Transplantation.
FAU - Shah, Ashish
AU  - Shah A
AD  - Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, 
      Tennessee.
FAU - Wigger, Mark
AU  - Wigger M
AD  - From the Division of Heart Failure and Transplantation.
FAU - Schlendorf, Kelly
AU  - Schlendorf K
AD  - From the Division of Heart Failure and Transplantation.
FAU - Keebler, Mary
AU  - Keebler M
AD  - From the Division of Heart Failure and Transplantation.
FAU - Danter, Matthew
AU  - Danter M
AD  - Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, 
      Tennessee.
FAU - Brown Sacks, Suzanne
AU  - Brown Sacks S
AD  - From the Division of Heart Failure and Transplantation.
FAU - Ooi, Henry
AU  - Ooi H
AD  - From the Division of Heart Failure and Transplantation.
FAU - Brinkley, Marshall
AU  - Brinkley M
AD  - From the Division of Heart Failure and Transplantation.
FAU - Hanna, Peter
AU  - Hanna P
AD  - From the Division of Heart Failure and Transplantation.
FAU - Zalawadiya, Sandip
AU  - Zalawadiya S
AD  - From the Division of Heart Failure and Transplantation.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 0 (Anticoagulants)
RN  - 0 (Blood Coagulation Factors)
RN  - 0 (Recombinant Proteins)
RN  - 37224-63-8 (prothrombin complex concentrates)
RN  - AC71R787OV (recombinant FVIIa)
RN  - EC 3.4.21.21 (Factor VIIa)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*adverse effects
MH  - Blood Coagulation Factors/therapeutic use
MH  - Factor VIIa/therapeutic use
MH  - Female
MH  - Heart Transplantation/*adverse effects
MH  - Heart-Assist Devices/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Recombinant Proteins/therapeutic use
MH  - Retrospective Studies
MH  - Thromboembolism/*etiology
EDAT- 2018/08/29 06:00
MHDA- 2020/05/13 06:00
CRDT- 2018/08/29 06:00
PHST- 2018/08/29 06:00 [pubmed]
PHST- 2020/05/13 06:00 [medline]
PHST- 2018/08/29 06:00 [entrez]
AID - 10.1097/MAT.0000000000000866 [doi]
PST - ppublish
SO  - ASAIO J. 2019 Sep/Oct;65(7):649-655. doi: 10.1097/MAT.0000000000000866.