A single-center experience of preemptive anticoagulation for patients with risk factors for allograft thrombosis in renal transplantation

Murashima, Miho; Konkle, Barbara A.; Bloom, Roy D.; Sood, Suman L.; Grossman, Robert; Brunelli, Steven M.; Stein, Steven

doi:10.5414/cnp74351

Cited by 24 publications

(28 citation statements)

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“…Therefore, the use of prophylactic anticoagulation has to be well balanced with the risk of postoperative bleeding. Some authors reported higher incidence of bleeding complications associated with routine use of prophylactic anticoagulation for KTRs [27,28] and several reports have suggested a low prevalence of DVT and pulmonary embolism in Asian populations, particularly in the Far East, when compared to western populations [18,19,20]. For these reasons, we used mechanical thromboprophylaxis modalities instead of anticoagulation as thromboprophylaxis and experienced a fairly low incidence of DVT.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thromboprophylaxis is sufficient to prevent the lower extremity deep vein thrombosis after kidney transplantation

et al. 2014

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PurposeDeep vein thrombosis (DVT) is a severe and common complication that occurs after the major operation. Despite the commonality of DVT there is limited data on the incidence of DVT after kidney transplantation (KT). Furthermore, most studies have been retrospective in design and were conducted in western countries. The aim of this study was to evaluate the incidence of lower extremity DVT with mechanical thromboprophylaxis within 1 month of KT in Korea.MethodsA total of 187 consecutive patients who underwent KT were included in this study. Patients used a graduated elastic stocking (n = 93) or an intermittent pneumatic compression device (n = 94) to prevent DVT. The frequency of DVT during the first month after KT was evaluated using serial color duplex ultrasound on postoperative days 7 ± 2, 14 ± 2, and 28 ± 3. All patients were tested for eight thrombophilic factors before KT.ResultsDVT occurred in four patients (2.1%) during the first month after KT. All DVT developed in the graduated elastic stocking group. Interestingly, none of the patients had the factor V Leiden mutation or the prothrombin gene 20210A mutation.ConclusionThe incidence of DVT in this study was relatively lower than that of western populations. We did not encounter a factor V Leiden mutation or a prothrombin gene 20210A mutation in our study population. These findings suggest that inherited thrombophilic risk factors may be partially responsible for the difference in DVT incidence rates between different nationalities and/or ethnicities.

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Section: Discussionmentioning

confidence: 99%

Mechanical thromboprophylaxis is sufficient to prevent the lower extremity deep vein thrombosis after kidney transplantation

et al. 2014

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“…Among them; the presence of CMV infection and cyclosporine or rapamycine administration after transplantation are basically observations and the mechanism of thrombogenicity about these drugs and infection are not fully demonstrated in high-powered clinical trials [13-15]. In addition; pretransplant hypercoagulable states as vascular access thromboses, prior venous thromboembolism, essential thrombocytemia, ischemic heart disease on antiplatelet therapy, atrial fibrillation on vitamin K antagonist therapy, factor V Leiden and prothrombin G20210A mutation and the presence of antiphospholipid antibodies have all been defined as independant risk factors for renal allograft thrombosis but not for posttransplant SVT in patients with optimal graft function [13,16,17]. The impact of JAK2V617F mutation in the pathogenesis of splanchnic vein and peripheral venous thrombosis and thromboses in MPD has been disclosed in detail [5,7,8,18-20].…”

Section: Discussionmentioning

confidence: 99%

Splanchnic vein thrombosis following renal transplantation: a case report

et al. 2013

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BackgroundRecurrent episodes of venous thrombosis have been closely correlated with JAK2 V617F mutation. Upto date, JAK2 gene mutation has not been defined as a prothrombic risk factor in renal transplant recipients. Herein; we present a case of portosplenic vein thrombosis in a primary renal transplant recipient with JAK2 V617F mutation who had no history of prior venous thromboembolism or thrombophilia.Case presentationA 59 year old female caucasian patient with primary kidney transplant admitted with vague abdominal pain at left upper quadrant. Abdominal doppler ultrasound and magnetic resonance imaging angiography demonstrated splanchnic vein thrombosis (SVT). The final diagnosis was SVT due to MPD (essential thrombocytosis, ET) with JAK2 V617F mutation. After 3 months of treatment with warfarin (≥5 mg/day, to keep target INR values of 1.9-2.5), control MRI angiography and doppler USG demonstrated partial (>%50) resolution of thrombosis with recanalization of hepatopedal venous flow. The patient is still on the same treatment protocol without any complication.ConclusionJAK2 V617F mutation analysis should be a routine procedure in the diagnosis and treatment of kidney transplant patients with thrombosis in uncommon sites.

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“…10,11 Repeated measurements either of anti Xa levels or aPTT or INR, and hence dose titration, are necessary not only to prevent thrombotic events perioperatively but also, to prevent postoperative hemorrhage in recipients with thrombophilic disorders. 12,13 In children with thrombophilia the incidence of graft thrombosis is higher than adults considering the fact that renal transplant in children with endstage renal disease has already 11.6% risk of acute graft thrombosis. 14 Children with end-stage renal disease and coexistent hypercoagulable disorders underwent successful living-related kidney transplants receiving proper perioperative anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

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Florou

Koukoulaki²,

Theodoros³

et al. 2017

Exp Clin Transplant

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Thrombophilia due to activated protein C resistance (Leiden mutation) is the most common inherited thrombophilic disorder with 5% incidence in whites. Renal transplant of these patients entails a risk of vascular thrombosis soon after the transplant; and acute rejection episodes and graft loss within the first year. We present a case of a successful living-related renal transplant in man with a recent history of repeat episodes of vascular access thrombosis attributed to inherited thrombophilia (heterozygosity for factor V mutation Q506 and homozygosity for mutation T677 for methylenetetrahydrofolate reductase). Transplant recipient was administered anticoagulation therapy with low molecular weight heparin pre-and postoperatively. No thrombotic or hemorrhagic events occurred posttransplant. A high suspicion of thrombophilic disorders in patients with end-stage renal disease with vascular access thrombotic events should be screened further to prevent failure of a subsequent renal transplant. Inherited thrombophilic disorders may not exclude living-related kidney transplant provided that anticoagulation therapy is administered perioperatively.

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A single-center experience of preemptive anticoagulation for patients with risk factors for allograft thrombosis in renal transplantation

Cited by 24 publications

References 0 publications

Mechanical thromboprophylaxis is sufficient to prevent the lower extremity deep vein thrombosis after kidney transplantation

Mechanical thromboprophylaxis is sufficient to prevent the lower extremity deep vein thrombosis after kidney transplantation

Splanchnic vein thrombosis following renal transplantation: a case report

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