Evaluation of Heparin Anticoagulation Protocols in Post–Renal Transplant Recipients (EHAP-PoRT Study)

Ng, Joan C. Y.; Leung, Marianna; Landsberg, David

doi:10.4212/cjhp.v69i2.1538

Cited by 9 publications

(19 citation statements)

References 14 publications

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“…Another study on bleeding risks after perioperative anticoagulation concluded that the utilization of antithrombotic prophylaxis does neither increase the incidence nor the risk for bleeding in the perioperative period, except for postoperative heparin infusion . Heparin infusion, starting within 24 h after surgery, has been associated with an increased risk for bleeding before , as in our analysis, whereas the prophylactic use of heparin (5000 IU s.c. twice daily) is reported to be safe . Others reported an increased risk of bleeding after continued VKA therapy as well, but concluded that the indication for VKA therapy was nonmodifiable in certain patients .…”

Section: Discussionmentioning

confidence: 99%

Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation – a retrospective study

et al. 2019

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SummaryPerioperative antithrombotic therapy could play a role in preventing thromboembolic complications (TEC) after kidney transplantation (KTx), but little is known on postoperative bleeding risks. This retrospective analysis comprises 2000 single‐organ KTx recipients transplanted between 2011 and 2016 in the two largest transplant centers of the Netherlands. TEC and bleeding events were scored ≤7 days post‐KTx. Primary analyses were for associations of antithrombotic therapy with incidence of TEC and bleeding. Secondary analyses were for associations of other potential risk factors. Mean age was 55 ± 14 years, 59% was male and 60% received a living donor kidney. Twenty‐one patients (1.1%) had a TEC. Multiple donor arteries [OR 2.79 (1.15–6.79)] and obesity [OR 2.85 (1.19–6.82)] were identified as potential risk factors for TEC. Bleeding occurred in 88 patients (4.4%) and incidence varied significantly between different antithrombotic therapies (P = 0.006). Cardiovascular disease [OR 2.01 (1.18–3.42)], pre‐emptive KTx [OR 2.23 (1.28–3.89)], postoperative heparin infusion [OR 1.69 (1.00–2.85)], and vitamin K antagonists [OR 6.60 (2.95–14.77)] were associated with an increased bleeding risk. Intraoperative heparin and antiplatelet therapy were not associated with increased bleeding risk. These regimens appear to be safe for the possible prevention of TEC without increasing the risk for bleeding after KTx.

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Section: Discussionmentioning

confidence: 99%

Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation – a retrospective study

et al. 2019

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“…Ng and co-workers evaluated several heparin anticoagulation protocols in the postoperative period after kidney transplantation [ 37 ]. They concluded that the prophylactic use of heparin (5000 IU UFH sc twice daily) is safe.…”

Section: Discussionmentioning

confidence: 99%

Preemptively and non-preemptively transplanted patients show a comparable hypercoagulable state prior to kidney transplantation compared to living kidney donors

et al. 2018

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To prevent renal graft thrombosis in kidney transplantation, centres use different perioperative anticoagulant strategies, based on various risk factors. In our centre, patients transplanted preemptively are considered at increased risk of renal graft thrombosis compared to patients who are dialysis-dependent at time of transplantation. Therefore these patients are given a single dose of 5000 IU unfractionated heparin intraoperatively before clamping of the vessels. We questioned whether there is a difference in haemostatic state between preemptively and non-preemptively transplanted patients and whether the distinction in intraoperative heparin administration used in our center is justified. For this analysis, citrate samples of patients participating in the VAPOR-1 trial were used and several haemostatic and fibrinolytic parameters were measured in 29 preemptively and 28 non-preemptively transplanted patients and compared to 37 living kidney donors. Sample points were: induction anaesthesia (T1), 5 minutes after reperfusion (T2) and 2 hours postoperative (T3). At T1, recipient groups showed comparable elevated levels of platelet factor 4 (PF4, indicating platelet activation), prothrombin fragment F1+2 and D-dimer (indicating coagulation activation) and Von Willebrand Factor (indicating endothelial activation) compared to the donors. The Clot Lysis Time (CLT, a measure of fibrinolytic potential) was prolonged in both recipient groups compared to the donors. At T3, F1+2, PF4 and CLT were higher in non-preemptively transplanted recipients compared to preemptively transplanted recipients. Compared to donors, non-preemptive recipients showed a prolonged CLT, but comparable levels of PF4 and D-dimer. In conclusion pre-transplantation, preemptively and non-preemptively transplanted patients show a comparable enhanced haemostatic state. A distinction in intraoperative heparin administration between preemptive and non-preemptive transplantation does not seem justified.

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“…Data are limited to a few retrospective studies conducted among patients undergoing renal transplantation. 50,51 The majority of those did not report higher incidence of bleeding in patients treated with perioperative heparin prophylaxis at renal transplantation, except one study. 50 In particular, Ng et al 51 recently reported results of the retrospective study on 547 renal transplantations and found bleeding complication in 8 of 266 patients (3%) who received heparin thromboprophylaxis and in 9 of 268 patients (3.4%) who did not.…”

Section: Prophylaxis Of Graft Thrombosis and Early Venous Thromboembomentioning

confidence: 98%

“…In very selected patients with high thrombosis risk, such as patients with aPL, in relation to the estimate of thrombotic risk as previously described, higher heparin dosages can be used when surgical conditions are stable, at least 48 hours after transplantation. In patients at particularly high thrombotic risk, the use of intravenous UFH at therapeutic dosages has been reported by some authors 51,52 ; however, this regimen was associated with an unacceptable high risk of serious bleeding (31-64.3% of cases). The adoption of anticoagulant dosages of heparin in the perioperative period of renal transplantation is associated with a high risk for bleeding and should be limited to highly selected patients, bearing in mind that the occurrence of bleeding complications will determine the temporary contraindication to antithrombotic treatment, exposing the patient also to a prolonged and even higher thrombotic risk.…”

Section: Prophylaxis Of Graft Thrombosis and Early Venous Thromboembomentioning

confidence: 99%

“…The adoption of anticoagulant dosages of heparin in the perioperative period of renal transplantation is associated with a high risk for bleeding and should be limited to highly selected patients, bearing in mind that the occurrence of bleeding complications will determine the temporary contraindication to antithrombotic treatment, exposing the patient also to a prolonged and even higher thrombotic risk. 51,53…”

Section: Prophylaxis Of Graft Thrombosis and Early Venous Thromboembomentioning

confidence: 99%

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Hemostatic Complications in Renal Transplantation

Poli

Antonucci²,

Zanazzi

2017

Semin Thromb Hemost

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Chronic kidney disease (CKD) represents the irreversible loss of the excretory and homeostatic functions of the kidney. Renal transplantation is the preferred treatment for patients with advanced CKD. Despite the availability of more effective immunosuppressive drugs and the improvements in surgical techniques, the development of complications can compromise early and long-term outcomes of renal transplantation. In particular, bleeding and thrombotic disorders can have impact on patient and graft survival. Risk stratification, early diagnosis, and appropriate interventions are critical to the management of these complications. Renal arterial and vein thrombosis are the most common vascular complications in the early phase after transplantation, whereas renal artery stenosis is a late event mainly related to surgery. Standard heparin thromboprophylaxis should be adopted in the perioperative period. Among renal transplant recipients, a high risk of venous thromboembolism (VTE) is reported. This risk persists long after transplantation, and patients with a previous episode of VTE are also at high risk for recurrence. An extended anticoagulant treatment should be considered, balancing the bleeding risk in a given patient. To date, the use of vitamin K antagonists remains preferred, given the risk of pharmacological interference with immunosuppressive agents and the renal metabolism of direct oral anticoagulants. In this review, bleeding and thrombotic complications of renal transplantation are described, and recommended thromboprophylaxis is discussed.

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Evaluation of Heparin Anticoagulation Protocols in Post–Renal Transplant Recipients (EHAP-PoRT Study)

Cited by 9 publications

References 14 publications

Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation – a retrospective study

Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation – a retrospective study

Preemptively and non-preemptively transplanted patients show a comparable hypercoagulable state prior to kidney transplantation compared to living kidney donors

Hemostatic Complications in Renal Transplantation

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