Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…These studies reported that VTE occurred more frequently following allogenic HSCT, in patients with a history of previous VTE or those with GVHD. 19,31 Most episodes of VTE in these studies were catheter related. Cortolezzi et al 32 have previously reported that there was a 12% incidence of catheter-related thromboembolic complications in a cohort of 416 patients with hematologic malignancies.…”

“…There was a non-statistically significant trend toward lower rates of thrombotic complications with thrombocytopenia. 32 GVHD has also been identified as a risk factor for VTE, [17][18][19] which has been attributed to the inflammatory milieu and endothelial activation. 28,29 In addition, some patients with GVH are treated with extracorporeal photopheresis that necessitates placement of a central venous catheter (CVC) for prolonged periods.…”

“…[17][18][19]30,31 In an analysis of 1514 patients undergoing HSCT as inpatients and followed for 180 days, Gerber et al 17 reported a 4.6% incidence of VTE, the majority of which were catheter related and all of which occurred after engraftment. Another retrospective series of 447 patients undergoing bone marrow transplantation reported a 5.7% incidence of VTE in the first 100 days following transplant despite being on heparin prophylaxis (100 U/kg IV daily) for hepatic sinusoidal obstruction syndrome.…”

“…In the studies mentioned above, the rate of bleeding in HSCT recipients ranges from 15.2 to 27.1%, and life-threatening or fatal bleeding occurred in 1.1-3.6% patients. [17][18][19] Gerber et al 17 reported that the initiation of therapeutic anticoagulation during days 1-180 after HSCT was the strongest predictor of bleeding (odds ratio (OR) 3 17 Given the competing risks of bleeding and thrombosis, identifying patients at high risk for these outcomes can be used to optimize strategies for VTE prophylaxis. Previous VTE is a well-recognized risk factor for VTE that may help target prophylaxis.…”

“…A 3.7% 1-year incidence of VTE, and 8-20% incidence of catheter-related thrombosis (CRT) have been reported in autologous stem cell transplant recipients. 12 HSCT recipients have several identifiable risk factors for thrombosis including malignancy, high-dose myeloablative chemotherapy and immune-modulatory drugs, [13][14][15][16] graft versus host disease (GVHD), [17][18][19] infections, 14,20 indwelling vascular catheters and prolonged immobilization. 14 HSCT is also associated with an 'acquired hypercoagulable state' characterized by inflammation, endothelial damage and activation of endothelium-dependent coagulation factors, increase in von Willebrand factor and platelet adhesion, increased thrombin generation, decreased anti-thrombin levels and decreased levels of anticoagulant proteins such as protein C. [21][22][23][24][25][26][27] graft versus host disease (GVHD) is associated with inflammation that leads to endothelial damage and activation.…”