A retrospective analysis of anticoagulant safety among heart transplant recipients undergoing endomyocardial biopsy.

Autor: Stock JC; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Carlquist J; The Ohio State University College of Medicine, Columbus, Ohio, USA., Melnyk M; The Ohio State University College of Medicine, Columbus, Ohio, USA., Smith S; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Bole I; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Patel V; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Emani S; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Foreman B; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Hasan A; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Franco V; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Lampert BC; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Haas GJ; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Vallakati A; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Ma J; The Ohio State University College of Medicine, Center for Biostatistics, Columbus, Ohio, USA., Peng J; The Ohio State University College of Medicine, Center for Biostatistics, Columbus, Ohio, USA., Boudoulas KD; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA., Kahwash R; The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Feb; Vol. 38 (2), pp. e15254.
DOI: 10.1111/ctr.15254
Abstrakt: Background: Transvenous endomyocardial biopsy is an invasive procedure which is used to diagnose rejection following an orthotopic heart transplant. Endomyocardial biopsy is widely regarded as low risk with all-cause complication rates below 5% in most safety studies. Following transplant, some patients require therapeutic anticoagulation. It is unknown whether anticoagulation increases endomyocardial biopsy bleeding risk.
Methods: Records from 2061 endomyocardial biopsies performed for post-transplant rejection surveillance at our institution between November 2016 and August 2022 were reviewed. Bleeding complications were defined as vascular access-related hematoma or bleeding, procedure-related red blood cell transfusion, and new pericardial effusion. Relative risk and small sample-adjusted 95% confidence interval was calculated to investigate the association between bleeding complications and anticoagulation.
Results and Conclusions: The overall risk of bleeding was 1.2% (25/2061 cases). There was a statistically significant increase in bleeding among patients on intravenous (RR 4.46, CI 1.09-18.32) but not oral anticoagulants (RR .62, CI .15-2.63) compared to patients without anticoagulant exposure. There was a trend toward increased bleeding among patients taking warfarin with INR ≥ 1.8 (RR 3.74, CI .90-15.43). Importantly, no bleeding events occurred in patients taking direct oral anticoagulants such as apixaban. Based on these results, intravenous rather than oral anticoagulation was associated with a significantly higher risk of bleeding complications following endomyocardial biopsy.
(© 2024 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: