Acil Cerrahi Öncesi Dabigatran Kullanan Hastada İdarucizumab Kullanımı
Özet
Atrial fibrilasyonu, koroner arter hastalığı, implante edilebilir kardiyoverter defibrilatörü (İKD) ve non-vitamin K antagonist oral antikoagülan (Dabigatran eteksilat) kullanım öyküsü olan 62 yaşında erkek hasta safra kesesi perforasyonu riski nedeniyle genel cerrahi tarafından acil olarak kolesistektomi yapılması amacıyla ameliyathaneye getirildi. Ameliyathanede yapılan anestezi öncesi değerlendirmede, İKD cihazının ayarlarının yapılmadığı ve hastanın 1 gün önce dabigatran eteksilat günde iki kez 150 mg kullandığı öğrenildi. Cihaz firması ve kardiyoloji doktoru ameliyathaneye çağrıldı. Cihazın ayarları kardiyoloji konsültasyonu önerileri doğrultusunda yapıldı. Cerrahi işleme başlamadan kardiyoloji ve literatürdeki öneriler doğrultusunda trombin pıhtılaşma zamanı değerlendirmesi mümkün olmadığı için hastanın kanama riski nedeniyle dabigatranın etkisini tersine çeviren ajan olarak kullanılan monoklonal antikor olan idarucizimab kullanımına karar verildi. İdarucizimab uygulaması 2,5 gr 5 dakika;10 dakika sonra 2,5 gr 5 dakika infüzyon olarak gerçekleştirildi. Hastada herhangi bir yan etki görülmedi. Kırk dakika süren cerrahide toplamda 200 mL kanama oldu. Cerrahi bittikten sonra hasta sorunsuz ekstübe edilerek yakın takip amacı ile yoğun bakım ünitesine alındı.
A 62-year-old male patient with a history of atrial fibrillation, coronary artery disease, implantable cardioverter defibrillator (ICD) and non-vitamin K antagonist oral anticoagulant (Dabigatran etexilate) use was brought to the operating room by the general surgeon for emergency cholecystectomy due to the risk of gallbladder perforation. In the pre-anesthesia evaluation performed in the operating room, it was learned that the settings of the ICD device were not made and the patient used dabigatran etexilate 150 mg twice a day the day before. The device company and the cardiologist were called to the operating room. The settings of the device were made in accordance with the recommendations of cardiology consultation. Since it was not possible to evaluate thrombin clotting time, in line with the recommendations in cardiology and the literature, before starting the surgical procedure, it was decided to use idarucizimab, a monoclonal antibody used as an agent that reverses the effect of dabigatran, due to the patient's bleeding risk. Idarucizimab was administered as 2.5 g in 5 minutes; 10 minutes later, 2.5 g in 5 minutes. The patient did not experience any side effects. There was a total of 200 cc of bleeding during the fourty-minute surgery. After the surgery was completed, the patient was extubated without any problems and taken to the intensive care unit for close monitoring.
Referanslar
Sklyar E, Bella JN. Evaluation and Monitoring of Patients With Cardiovascular Implantable Electronic Devices Undergoing Noncardiac Surgery. Health Serv Insights. 2017;10:1-5. doi: 10.1177/1178632916686073.
Polat F, Karadağ B. İmplante Edilebilir Kardiyoverter Defibrilatörlü Hastaların Klinik ve Demografik Özellikleri ile Cihaz Olayları Hastaneye Yatış ve Mortalite Arasındaki İlişki. MN Kardiyoloji. 2023;30(3):102¬113
Oğuz M, Akbulut T, Aktaş M, et al. Post-STEMI Hastalarında İmplante Edilebilir Kardiyoverter Defibrilatör İmplantasyon Zamanlamasının Karşılaştırılması: Geriye Dönük Ventriküler Aritmik Analiz. MN Kardiyoloji. 2023;30(4):117-123.
Thomas H, Plummer C,Wright I.J et al. Guidelines for the peri-operative management of people with cardiac implantable electronic devices. Anaesthesia. 2022; 77, 808–817. doi:10.1111/anae.15728.
Neubauer H, Wellmann M, Herzog-Niescery J et al. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). Pacing Clin Electrophysiol. 2018;41:1536–1542. doi: 10.1111/pace.13514
Cosentino F, Grant PJ, Aboyans V et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. ESC Scientific Document Group. Eur Heart J. 2020;41(2):255-323. doi: 10.1093/eurheartj/ehz486.PMID: 31497854
Bilgehan K, İkitimur B, Öngen Z. Yeni oral antikoagulan ve antiagregan ilaçları kullanan hastalarda perioperatif yaklaşım. Turk Kardiyol Dern Ars. 2012; 40(6): 548-551. doi: 10.5543.
Haastrup S.B, Hellfritzsch M, Nybo M et al. Real-world experience with reversal of dabigatran by idarucizumab. Thromb Res. 2021;197:179-184. doi: 10.1016/j.thromres.2020.11.010.
Ferro J.M, Coutinho J.M, Dentali F et al. Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis: A Randomized Clinical Trial. JAMA Neurol. 2019;76 (12):1457-1465.doi: 10.1001/jamaneurol.2019.2764.
Peacock W.F, Grotta J.C, Thorsten Steiner T. Idarucizumab for Reversal of Dabigatran in Early/Emergency Surgeries: A Case Series. J Emerg Med. 2019;57(6):e167-e173. doi: 10.1016/j.jemermed.2019.09.038.
Shaw J.R, Kaplovitch E, Douketis J. Periprocedural Management of Oral Anticoagulation. 2020;20:1-18.doi: 10.1016/j.mcna.2020.02.005
Kim K-S, Song J.W, Soh S et al. Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations. Anesth Pain Med.2020;15:133-142. /10.17085/apm.2020.15.2.17
Levy JH, Ageno W, Chan NC et al. When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. J Thromb Haemost 2016; 14:623–627.
Talari G, Demertzis ZD, Summey RD et al. Perioperative management of anticoagulation. Hosp Pract (1995). 2020;48(5):231-240. doi: 10.1080/21548331.2020.1792138.
Cuker A, Burnett A, Triller D et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019;94(6):697-709. doi: 10.1002/ajh.25475.
Douketis J.D, MD, Spyropoulos A.C, Duncan J. et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med. 2019 ; 179(11): 1469–1478. doi: 10.1001/jamainternmed.2019.2431.
Tripodi A. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures. J Thromb Haemost.2016; 14: 1325–1327.
Syed YY. Idarucizumab: A Review as a Reversal Agent for Dabigatran. Am J Cardiovasc Drugs. 2016;16(4):297-304. doi: 10.1007/s40256-016-0181-4.
Giannandrea D, Mengoni A, Carluccio E et al. Practical considerations on anticoagulation reversal: spotlight on the reversal of dabigatran. Vasc Health Risk Manag. 2019; 15:139-142. doi: 10.2147/VHRM.S181806.
Tsai Y-T, Hsiao Y-J, Tsai L-K et al. Idarucizumab-facilitated intravenous thrombolysis in acute stroke with dabigatran: Two cases with hemorrhagic transformation. J Neurol Sci. 2018;388:155-157.doi: 10.1016/j.jns.2018.03.021.
Pollack CV, Reilly PA, Eikelboom J et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511–20. http://dx.doi.org/10.1056/NEJMoa1502000.
Referanslar
Sklyar E, Bella JN. Evaluation and Monitoring of Patients With Cardiovascular Implantable Electronic Devices Undergoing Noncardiac Surgery. Health Serv Insights. 2017;10:1-5. doi: 10.1177/1178632916686073.
Polat F, Karadağ B. İmplante Edilebilir Kardiyoverter Defibrilatörlü Hastaların Klinik ve Demografik Özellikleri ile Cihaz Olayları Hastaneye Yatış ve Mortalite Arasındaki İlişki. MN Kardiyoloji. 2023;30(3):102¬113
Oğuz M, Akbulut T, Aktaş M, et al. Post-STEMI Hastalarında İmplante Edilebilir Kardiyoverter Defibrilatör İmplantasyon Zamanlamasının Karşılaştırılması: Geriye Dönük Ventriküler Aritmik Analiz. MN Kardiyoloji. 2023;30(4):117-123.
Thomas H, Plummer C,Wright I.J et al. Guidelines for the peri-operative management of people with cardiac implantable electronic devices. Anaesthesia. 2022; 77, 808–817. doi:10.1111/anae.15728.
Neubauer H, Wellmann M, Herzog-Niescery J et al. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). Pacing Clin Electrophysiol. 2018;41:1536–1542. doi: 10.1111/pace.13514
Cosentino F, Grant PJ, Aboyans V et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. ESC Scientific Document Group. Eur Heart J. 2020;41(2):255-323. doi: 10.1093/eurheartj/ehz486.PMID: 31497854
Bilgehan K, İkitimur B, Öngen Z. Yeni oral antikoagulan ve antiagregan ilaçları kullanan hastalarda perioperatif yaklaşım. Turk Kardiyol Dern Ars. 2012; 40(6): 548-551. doi: 10.5543.
Haastrup S.B, Hellfritzsch M, Nybo M et al. Real-world experience with reversal of dabigatran by idarucizumab. Thromb Res. 2021;197:179-184. doi: 10.1016/j.thromres.2020.11.010.
Ferro J.M, Coutinho J.M, Dentali F et al. Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis: A Randomized Clinical Trial. JAMA Neurol. 2019;76 (12):1457-1465.doi: 10.1001/jamaneurol.2019.2764.
Peacock W.F, Grotta J.C, Thorsten Steiner T. Idarucizumab for Reversal of Dabigatran in Early/Emergency Surgeries: A Case Series. J Emerg Med. 2019;57(6):e167-e173. doi: 10.1016/j.jemermed.2019.09.038.
Shaw J.R, Kaplovitch E, Douketis J. Periprocedural Management of Oral Anticoagulation. 2020;20:1-18.doi: 10.1016/j.mcna.2020.02.005
Kim K-S, Song J.W, Soh S et al. Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations. Anesth Pain Med.2020;15:133-142. /10.17085/apm.2020.15.2.17
Levy JH, Ageno W, Chan NC et al. When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. J Thromb Haemost 2016; 14:623–627.
Talari G, Demertzis ZD, Summey RD et al. Perioperative management of anticoagulation. Hosp Pract (1995). 2020;48(5):231-240. doi: 10.1080/21548331.2020.1792138.
Cuker A, Burnett A, Triller D et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019;94(6):697-709. doi: 10.1002/ajh.25475.
Douketis J.D, MD, Spyropoulos A.C, Duncan J. et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med. 2019 ; 179(11): 1469–1478. doi: 10.1001/jamainternmed.2019.2431.
Tripodi A. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures. J Thromb Haemost.2016; 14: 1325–1327.
Syed YY. Idarucizumab: A Review as a Reversal Agent for Dabigatran. Am J Cardiovasc Drugs. 2016;16(4):297-304. doi: 10.1007/s40256-016-0181-4.
Giannandrea D, Mengoni A, Carluccio E et al. Practical considerations on anticoagulation reversal: spotlight on the reversal of dabigatran. Vasc Health Risk Manag. 2019; 15:139-142. doi: 10.2147/VHRM.S181806.
Tsai Y-T, Hsiao Y-J, Tsai L-K et al. Idarucizumab-facilitated intravenous thrombolysis in acute stroke with dabigatran: Two cases with hemorrhagic transformation. J Neurol Sci. 2018;388:155-157.doi: 10.1016/j.jns.2018.03.021.
Pollack CV, Reilly PA, Eikelboom J et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511–20. http://dx.doi.org/10.1056/NEJMoa1502000.
