Efficacy and Safety of Low Molecular Weight Heparin in Renal Transplantation1

Alkhunaizi, Ahmed M.; Olyaei, Ali J.; Barry, John M.; DeMattos, Angelo M; Conlin, Michael J.; Lemmers, Michael J.; Bennett, William M.; Norman, Douglas J.

doi:10.1097/00007890-199808270-00020

Cited by 43 publications

(25 citation statements)

References 7 publications

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“…These differences in factors associated with an increased risk of thrombosis may account for the increased incidence of graft thrombosis in our study. Unlike other studies [1,5,10], we were unable to show any benefit of heparin on graft thrombosis, despite the fact that there was an increased incidence of risk factors in the non-heparin group, with a lower mean donor age (reflecting the lack of awareness at that time of the increased risks associated with young donors) and a higher mean CIT, which may have adversely affected the outcome for this group. Broyer et al [1] reported that heparinisation in children with identified risk factors (age less than 5 years, donor grafts with multiple vessels, grafts with intimal lesions of the renal artery, and known abnormalities of coagulation suggested by recurrent fistula thrombosis with documented haemostasis abnormalities) reduced the incidence of graft loss secondary to a thrombotic event from 12.3% to 1.5%.…”

Section: Discussioncontrasting

confidence: 99%

“…Broyer et al [1] reported that the use of preventative LMWH was associated with an increased risk of haemorrhagic complications, frequently resulting in an increased need for blood transfusions and return to theatre for re-exploration. Ubhi et al [5] and Alkhunaizi et al [10], however, found that heparin reduced the incidence of graft thrombosis, but without a significant risk of bleeding. Our experience during 1999-2001 would support the findings of Broyer et al [1].…”

Section: Discussionmentioning

confidence: 99%

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The effect of heparin on graft thrombosis in pediatric renal allografts

et al. 2004

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Graft thrombosis is an important cause of early (<4 weeks) renal graft loss. Reports show that heparin reduces the incidence of early renal allograft thrombosis. Routine peri-operative administration of unfractionated heparin was introduced in our unit in 1994. We conducted a retrospective study of 254 transplants, undertaken in children, between 1987 and 2000. There were 126 children who did not receive heparin (group 1) and 128 who did (group 2). Recipient characteristics and immunosuppression were similar in both groups. The incidence of graft loss secondary to thrombosis was compared between the groups. Variables previously identified with increased risk of graft loss, including donor age, recipient age, cold ischaemia time (CIT), multiple donor vessels, surgical complications, and side of graft donation, were examined using logistic regression. Thrombosis occurred in 14 grafts in group 1 and 11 grafts in group 2 (odds ratio 0.7, 95% confidence interval 0.3-1.6, P=not significant). The mean time to graft loss was similar in groups 1 and 2 (6.6, SD 3.9, range 2-12 days and 7.9, SD 4.4, range 1-14 days, respectively) ( P=0.445). Young recipient age ( P=0.006), young donor age ( P=0.009), increasing CIT ( P=0.007), and surgical complications ( P=0.002) increased the risk of graft thrombosis. A reduction in the incidence of early renal allograft thrombosis upon introduction of heparin was not demonstrated.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of heparin on graft thrombosis in pediatric renal allografts

et al. 2004

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“…of standard heparin dramatically lowered the incidence of DVT following transplantation. Similar results were achieved with low molecular weight heparin, which was given in low or high doses according to the clinical situation [37]. In the case of an inherited or acquired thrombophilia the treatment has to be adjusted to the severity of the disorder.…”

Section: Therapymentioning

confidence: 65%

Do we need screening for thrombophilia prior to kidney transplantation?

Andrassy¹

2004

Nephrology Dialysis Transplantation

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Background. There is increased risk for the occurrence of deep venous thrombosis (DVT) and renovascular thrombosis after kidney transplantation. A disruption of the blood homeostasis caused by surgery and leading to clotting and bleeding malfunctions is widely accepted. However, other causes such as inherited or acquired disorders of the clotting system may further increase the risk of thrombosis. Here, we summarize and review data on possible causes, incidence and ways to prevent the occurrence of DVT and/or renovascular thrombosis after kidney transplantation. Results. The incidence of DVT after kidney transplantation is 6.2-8.3% and 25% of these patients suffer from pulmonary embolism. The DVT occurs primarily on the side of the transplant with an increased risk throughout the first 5 months after transplantation. Thereby, 2-12% of the patients develop renovascular thromboses, most of which are related directly to the surgery. However, inherited or acquired thrombophilia may also play an important role. A severe course is known for prothrombin gene G20210A polymorphism, which can result in graft loss. A great diversity of prophylactic treatments is available but adjustment to the underlying circumstances is crucial for a favourable outcome. Low-dose heparin prophylaxis for at least 2-3 weeks can be used as standard therapy to prevent the occurrence of DVT after kidney transplantation. However, this may not be sufficient for concurrent disorders of the blood homeostasis such as elevated levels of antiphospholipid antibodies, lupus anticoagulant, prothrombin gene G20210A polymorphism or a combined inherited thrombophilia. These patients may need a prophylactic anticoagulation with coumarins starting prior to transplantation and being continued for at least 1 year or even lifelong. Only randomized trials can answer the question concerning optimal duration and safety of coumarins in this setting.Conclusions. DVT and/or renovascular thromboses are severe complications after kidney transplantation. Inherited and acquired thrombophilia, apart from surgery and abnormal anatomy itself, have to be considered and proper prophylactic treatment initiated.

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“…Another series reported no episodes of allograft thrombosis after 235 consecutive transplants performed after the introduction of a similar strategy of screening and postoperative anticoagulation in high-risk patients with thrombophilia (26). The reported rates of serious bleeding range from 0% to 60% in these series and include retroperitoneal hemorrhages requiring surgical evacuation (54,55). These widely variable bleeding rates may reflect differences in the intensity and monitoring of anticoagulation.…”

Section: Treatmentmentioning

confidence: 91%

“…Patients with thrombophilia or a history of venous or repeated vascular access thrombosis received a higher dose of lowmolecular-weight heparin for 1 month followed by warfarin. One patient developed a thrombus at the tip of a subclavian central line, but there were no graft vessel thromboses or other thrombotic complications (54). In another study, 502 renal transplant patients with a history of thrombosis or other risk factors were screened for thrombophilic disorders.…”

Section: Treatmentmentioning

confidence: 99%