Deep vein thrombosis and pulmonary embolism after solid organ transplantation: an unresolved problem

Sáez-Giménez, Berta; Berastegui, Cristina; Loor, Karina; Meseguer, Manuel López; Monforte, Vı́ctor; Bravo, Carlos; Santamaría, Amparo

doi:10.1016/j.trre.2014.12.005

Cited by 47 publications

(54 citation statements)

References 65 publications

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“…Solid organ transplant recipients are more likely to require anticoagulation for either AF or VTE comparatively to the general population 9,10 . However, no controlled trials exist investigating DOAC use in solid organ transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly, solid organ transplant recipients demonstrate unique pharmacokinetic considerations regarding renal and hepatic function as well as drug‐drug interactions 8 . Transplant recipients also experience AF and VTE at a higher rate than the general population, making DOAC therapy an inciting treatment option for providers over traditional vitamin K antagonist therapy despite the lack of prospective data 9,10 . Currently, the data examining DOAC utilization in transplant recipients is limited to single‐center retrospective assessments 8 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Lichvar

Pierce

Salerno

et al. 2020

Clinical Transplantation

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The safety and efficacy of direct‐acting oral anticoagulants (DOACs) and reversal strategies are not well established in the solid organ transplant population. This was a survey of pharmacists to assess DOAC and urgent reversal practices among adult transplant programs in the United States. A 27‐question survey was distributed to members of transplant pharmacy organization listservs between 5/28/19 and 6/30/19. A total of 115 responses were received from kidney (43.5%), heart (20.0%), lung (18.3%), liver (13.9%), and pancreas (4.4%) transplant programs. DOAC use prior to transplant was mostly prohibited in thoracic programs (77.3%) but more permissive in kidney transplant programs (64.0%). If permitted, apixaban (57.8%) was most preferred. At transplant surgery, reversal of DOAC was performed “as needed” (20.9%) or was not routine (18.3%). DOAC use post‐transplant was more permissive (94.3%). A majority of responders follow FDA recommended dosing in the setting of drug‐drug interactions (51.1%). Major factors influencing DOAC prescribing decisions included renal function, drug‐drug interactions, and insurance. High clinical practice variability exists regarding DOAC utilization and urgent reversal strategies in pre‐, peri‐, and post‐transplant stages. While more research is needed to refine the clinical landscape, many institutions are using DOAC therapy under the perception that they pose a similar risk of bleeding compared to a non‐transplant population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Lichvar

Pierce

Salerno

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

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“…Lung transplantation is frequently complicated by VTE with a reported incidence of 8%‐45% . There are a number of traditional risk factors responsible for the increased incidence of VTE post‐transplantation including stasis, indwelling catheters, and a postoperative state.…”

Section: Resultsmentioning

confidence: 99%

Early postoperative management after lung transplantation: Results of an international survey

King

Valentine

Cattamanchi

et al. 2017

Clinical Transplantation

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“…Venous thromboembolism (VTE) is a major complication after surgery. A previous review of the literature highlights the importance of this issue after solid organ transplantation (SOT) [1]. The incidence of VTE ranges between 2% and 14% in kidney transplantation [2], between 3% and 5% in liver transplantation [3][4][5][6][7], between 18% and 34% in heart transplantation, and between 8% and 29% in lung transplantation (LT) [8][9][10][11][12][13][14].…”

Section: Introductionmentioning

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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Deep vein thrombosis and pulmonary embolism after solid organ transplantation: an unresolved problem

Cited by 47 publications

References 65 publications

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Early postoperative management after lung transplantation: Results of an international survey

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

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