Ischemic Heart Disease in Liver Transplant Candidates With High Bleeding Risk: Any Way Out?

Coronary artery disease in candidates for liver transplantation is a real challenge because of the need to balance the risks of bleeding and thrombosis. Antiplatelet therapy, essential to prevent thrombotic events, may increase the risk of hemorrhagic complications, especially in the context of hepatic surgery. A 71-year-old woman with end-stage liver disease (ESLD) presented for a pretransplantation evaluation. She received a diagnosis of significant coronary artery disease (CAD), and a multidisciplinary discussion resulted in the option for an invasive treatment with several precautions to minimize her bleeding risk. Because of the intricacy of underlying comorbidities and the elevated perioperative risk, managing CAD in patients with ESLD is particularly challenging. More research and evidence are needed on treating CAD in this patient group. Patients with ESLD who are waiting for liver transplantation should have CAD actively screened. Multidisciplinary treatment is crucial to maximizing the results.