Anticoagulation before, during, and after heart transplantation presents unique challenges to clinicians. Bleeding and thrombotic morbidity continues to affect this patient population throughout all phases of the transplant journey. Reversal is commonly required since patients are commonly bridged to transplantation with left ventricular assist devices, which require chronic anti platelet and anticoagulation. Caution must be exercised in patients requiring cardiopulmonary bypass during surgery who are at risk of complications from heparin induced thrombocytopenia. The reported incidence of venous thromboembolism following heart transplantation is high, particularly during the first post-transplant year, most likely due to surgery, biopsies, specific immunosuppression (mTOR inhibitors) and immobilization. It is crucial to maintain long-term oral anticoagulation after the first venous thromboembolism event, especially when risk factors exist. A major issue, and one for which there remains considerable debate, is the optimal treatment of such complications, particularly upper extremity venous thrombosis. For both warfarin and the thrombin inhibitors or Factor Xa inhibitors, the clinician must determine potential drug interactions based on the heart transplantation drug regimen, and then develop a patient-specific management strategy.

中文翻译：

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撤回：心脏移植中的抗凝治疗策略。

心脏移植之前，期间和之后的抗凝对临床医生提出了独特的挑战。在移植过程的所有阶段，出血和血栓形成的发病率继续影响着该患者人群。通常需要逆转，因为患者通常通过左心室辅助装置桥接至移植，这需要长期抗血小板和抗凝。手术期间需要进行体外循环的患者有肝素诱导的血小板减少症并发症的风险，必须谨慎行事。据报道，心脏移植后静脉血栓栓塞的发生率很高，尤其是在移植后的第一年，这很可能是由于手术，活检，特异性免疫抑制（mTOR抑制剂）和固定化所致。在首次静脉血栓栓塞事件发生后，尤其是在存在危险因素的情况下，维持长期口服抗凝至关重要。一个重要的问题，尤其是上肢静脉血栓形成的最佳治疗方法，仍然是引起争议的一个问题。对于华法林和凝血酶抑制剂或Xa因子抑制剂，临床医生必须根据心脏移植药物方案确定潜在的药物相互作用，然后制定针对患者的治疗策略。