Administration of Dalteparin Based on the Activated Clotting Time for Prophylaxis of Hepatic Vessel Thrombosis in Living Donor Liver Transplantation

Uchikawa, Yuji; Ikegami, Toshihiko; Masuda, Yuki; Ohno, Yasunari; Mita, Atsuyoshi; Urata, Koichi; Nakazawa, Yūichi; Terada, Masaru; Miyagawa, S.

doi:10.1016/j.transproceed.2009.04.011

Cited by 9 publications

(11 citation statements)

References 26 publications

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“…The literature search yielded 634 articles; after the removal of all the articles that did not reflect the inclusion and exclusion criteria, a total of 11 articles[ 62 , 71 - 79 ] published between 1997 and 2018 were included in this systematic review. Three studies were prospective[ 71 , 76 , 80 ], only one was a prospective case control study[ 75 ] while all the others were retrospective[ 61 , 72 , 74 ] and four of these had control group[ 73 , 77 - 79 ]; No papers reported multicentric data. All these studies included a total of 5192 patients (adult and children).…”

Section: Role Of Thromboprophylaxismentioning

confidence: 99%

“…Gad and colleagues[ 74 ], in a retrospective work on 222 adult and pediatric living-donor LTs, reported their standard prophylactic therapy (heparin infusion up to 180-200 units/kg per day adjusted with reference to the ACT and/or the aPTT) and concluded that a more intensive anticoagulation therapy could be one option, especially when dealing with preoperative PVT. Uchikawa et al[ 75 ], fearing bleeding complications associated with UFH administration, proposed a thromboprophylactic regimen with dalteparin, a relatively selective inhibitor of factor Xa activity. In their prospective case-control group, they showed that anticoagulation therapy, based on ACT, reduces thrombotic complications without increasing bleeding[ 75 ].…”

Section: Role Of Thromboprophylaxismentioning

confidence: 99%

“…Uchikawa et al[ 75 ], fearing bleeding complications associated with UFH administration, proposed a thromboprophylactic regimen with dalteparin, a relatively selective inhibitor of factor Xa activity. In their prospective case-control group, they showed that anticoagulation therapy, based on ACT, reduces thrombotic complications without increasing bleeding[ 75 ]. Similarly, Sugawara et al[ 76 ] demonstrated the efficacy of intensive anticoagulation obtained with low-molecular-weight heparin (LMWH) administration.…”

Section: Role Of Thromboprophylaxismentioning

confidence: 99%

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Perioperative thromboprophylaxis in liver transplant patients

Pietri

Montalti

Nicolini

et al. 2018

WJG

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Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation (LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications (intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors (portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis’’ can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors (venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT.

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Section: Role Of Thromboprophylaxismentioning

confidence: 99%

Section: Role Of Thromboprophylaxismentioning

confidence: 99%

Section: Role Of Thromboprophylaxismentioning

confidence: 99%

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Perioperative thromboprophylaxis in liver transplant patients

Pietri

Montalti

Nicolini

et al. 2018

WJG

View full text Add to dashboard Cite

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“…These studies showed inconsistent results for the balance between bleeding risk and thrombotic events. Heparin implies a significant increase in bleeding complications in both kidney and liver transplantation [28][29][30][31][32][33], but treatment with dalteparin adjusted for activated clotting time in liver transplantation seems to be safe [22]. Prophylaxis of renal or liver allograft thrombosis with aspirin alone seems to be another good option that does not increase the frequency of bleeding complications [17][18][19][20][21], although doses differ between studies.…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study

et al. 2017

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Venous thromboembolism (VTE) is a frequent complication after solid organ transplantation (SOT) and, specifically, after lung transplantation (LT). The objectives of this study were to evaluate prophylaxis with enoxaparin and to describe risk factors for VTE after LT. We retrospectively reviewed the clinical records of 333 patients who underwent LT in our institution between 2009 and 2014. We compared two consecutive cohorts: one that received enoxaparin only during post-transplant hospital admissions and a second cohort that received 90-day extended prophylaxis with enoxaparin. Cumulative incidence function for competing risk analysis was used to determine incidence of VTE during the first year after transplantation. Risk factors were analyzed using a Cox proportional hazards regression model. The cumulative incidence of VTE was 15.3% (95% CI: 11.6-19.4). Median time from transplant to the event was 40 (p25-p75, 14-112) days. Ninety-day extended prophylaxis did not reduce the incidence of VTE. In this study, the risk factors associated with VTE were male gender and interstitial lung disease. VTE is a major complication after LT, and 90-day extended prophylaxis was not able to prevent it. Large, multicenter, randomized clinical trials should be performed to define the best strategy for preventing VTE.

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“…ACT POCTs were developed to monitor high-dose heparin therapy and guide protamine administration, mainly in cardiovascular surgery. ACT-guided postoperative thromboprophylaxis regimens for patients undergoing living donor OLT to reduce risk of hepatic artery thrombosis (HAT) have been reported 13 and may warrant further exploration.…”

Section: Activated Clotting Timementioning

confidence: 99%

Point-of-Care Testing in Liver Disease and Liver Surgery

Abeysundara

Mallett

Clevenger

2017

Semin Thromb Hemost

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The alterations in coagulation and hemostasis that accompany liver disease are complex, and while patients with this disease have traditionally been perceived as having a bleeding diathesis, it is now understood that in stable patients hemostasis is "re-balanced." Hepatic surgery, and particularly liver transplantation, can be associated with large fluid shifts, massive bleeding, and coagulopathy, as well as postoperative thrombosis. Point-of-care tests (POCTs) of coagulation facilitate goal-directed treatments and hemostatic monitoring in dynamic environments where the coagulation status can alter rapidly and often unpredictably. POCTs reflect more accurately the re-balanced hemostatic system than do conventional coagulation tests (CCTs). Viscoelastic POCT-guided transfusion algorithms permit a reduction in blood product administration and are a key component of patient blood management programs. Moreover, viscoelastic POCTs are better able to identify patients with hypercoagulability than CCTs. With thrombosis increasingly recognized to be a problem in patients with liver disease, POCTs hold promise for both individualized bleeding and thrombosis management.

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Administration of Dalteparin Based on the Activated Clotting Time for Prophylaxis of Hepatic Vessel Thrombosis in Living Donor Liver Transplantation

Cited by 9 publications

References 26 publications

Perioperative thromboprophylaxis in liver transplant patients

Perioperative thromboprophylaxis in liver transplant patients

Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study

Point-of-Care Testing in Liver Disease and Liver Surgery

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