Presentation Details
| Benefit of albumin infusion in an elderly cirrhotic patient on DOAC: about a case . LAMIA AIT OUALI1, FARID SLIMANI2, SAMIA OULARBI1, SAMIR TINE1, 3. 1APHP René Muret, Sevran, France.2APHP Jean Verdier, Bondy, France.3APHP Avicenne, Bobigny, France |
Abstract
Introduction : Hypoalbuminemia is frequently observed in patients with decompensation of cirrhosis, which is aggravated by nutritional status, renal insufficiency which are frequent complications in the elderly, leading to infectious, hemodynamic, hydroelectrolyte complications, and the increase in the bioavailability of certain drugs such as DOACs.Albumin infusion, alone or in combination with other drugs, has been proposed for the treatment of various complications of cirrhosis. We propose to look at the case of our cirrhotic patient Child-Pugh A on DOAC who was infused with Albumin. Observation: This is an 89-year-old patient with a history of type II diabetes, moderate chronic kidney disease, cirrhosis on DOAC for atrial fibrillation. Admitted to geriatric SSR for reautomonization following oedematoascitic decompensation on urinary sepsis. Clinically upon arrival: Infectious: urinary sepsis with ESBL germs Klebsiella pneumoniae. Hepatic: oedematoascitic decompensation on cirrhosis. In terms of haemostasis: Persistent gross haematuria and epistaxis, on Dabigatran with a haemorrhagic score of 4.right posterior tibial DVT. Renal: Hepatorenal syndrome. Pulmonary: PNP at SARSCOV2. Nutritionally severe undernutrition with albuminemia at 19.9mg/l prealbuminemia 0.06mg/l. The infusion of 1g/kg of albumin improved the clinical picture of our patient. Discussion: The perfusion of albumin during cirrhosis is interesting in the correction of hemodynamic complications by increasing oncotic pressure, infectious by decreasing the bioavailability of prostaglandin, but also by decreasing the bioavailability of DOACs thus limiting the risk of overdose, increased by renal failure and hypoalbuminemia. Conclusion: Our observation allows us to deduce that albumin infusion improves the clinical condition of cirrhotic patients with severe hypoalbuminemia under DOAC, but no study has demonstrated its interest in limiting the risk of bleeding in these patients.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.