Venous thromboembolism in heart transplant recipients: Incidence, recurrence and predisposing factors

Álvarez‐Álvarez, Rolando J.; Barge‐Caballero, Eduardo; Chávez-Leal, Sergio; Paniagua‐Martin, María J.; Marzoa-Rivas, Raquel; Caamaño, Cayetana-Barbeito; López-Sainz, Ángela; Grille-Cancela, Zulaika; Blanco-Canosa, Paula; Herrera-Noreña, José M.; Cuenca-Castillo, José J.; Castro‐Beiras, Alfonso; Crespo-Leiro, María G.

doi:10.1016/j.healun.2014.09.039

Cited by 30 publications

(32 citation statements)

References 26 publications

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“…Our heart transplant population had a VTE incidence of 9.3% that is similar to the 8.5% incidence in the recent observational study by Alvarez‐Alvarez et al. .…”

Section: Discussionsupporting

confidence: 87%

“…A 2001 retrospective study examining thrombotic complications in heart transplant patients treated post‐operatively with antiplatelet regimens found that 18% of patients had evidence of either arterial or venous thrombosis, with no statistically significant difference in overall mortality relative to the control group . Most recently, a single‐center cohort of 635 heart transplant patients followed for a median post‐transplant period of 8.4 yr had incidence rates of VTE, DVT, and PE of 12.7, 8.4, and 7.0 episodes per 1000 patient‐years .…”

Section: Discussionmentioning

confidence: 99%

“…In the general population, recurrence rate is 10% annually irrespective of the duration of warfarin therapy . Among heart transplant patients, the incidence rate of VTE recurrence has been shown to be 30.5 (95% CI 13.2–60.2) episodes per 1000 patient‐years, mostly in patients in whom oral anticoagulation had been completed . While treatment with warfarin post‐VTE has been shown to strongly reduce the VTE recurrence rate, it is not associated with reduction in mortality and an elevated risk for major bleeding remains .…”

Section: Discussionmentioning

confidence: 99%

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Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Elboudwarej¹,

Patel²,

Liou³

et al. 2015

Clinical Transplantation

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“…Our heart transplant population had a VTE incidence of 9.3% that is similar to the 8.5% incidence in the recent observational study by Alvarez‐Alvarez et al. .…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Elboudwarej¹,

Patel²,

Liou³

et al. 2015

Clinical Transplantation

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“…As complex and unpredictable in onset and severity, a few risk factors for venous thromboembolism after liver transplantation were identified, for example, prolonged immobilization, administration of excessive procoagulant factors, and peripherally inserted central catheter lines [14,15]. Other factors involved defects in the proteins that normally regulated anticoagulation, such as protein C, protein S, and antithrombin deficiency, transmitted from donors to recipients [29][30][31][32], and this can be missed Similarly, kidney and heart transplant recipients have been reported to be at risk of venous thromboembolism as mentioned previously [16,18,[33][34][35]. In heart transplant recipients, Elboudwarej et al [19] even demonstrated that lower extremity DVT posed a high risk of pulmonary embolism and death despite use of thromboprophylactic regimens.…”

Section: Discussionmentioning

confidence: 96%

Cardiovascular disease risk in patients receiving organ transplantation: a national cohort study

et al. 2017

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Although organ transplantation is the definitive treatment for end-stage organ failure, the post-transplant outcomes can be substantially influenced by cardiovascular complications. A national cohort study was performed to estimate risks of cardiovascular diseases in those with heart, lung, kidney, and liver transplantation. This cohort study consisted of 5978 solid organ transplantations identified using the Taiwan National Health Insurance Database. Cardiovascular and mortality risks in transplant recipients were evaluated using standardized incidence ratios, excess absolute risks, and standardized mortality ratios as compared to those in the general population. In heart, kidney, and liver recipients, the standardized incidence ratios of overall cardiovascular diseases were 9.41 (7.75-11.44), 3.32 (2.29-3.77), and 1.4 (1.15-1.7) and the overall standardized mortality ratios were 5.23 (4.54-6.03), 1.48 (1.34-1.63), and 3.95 (3.64-4.28), respectively. Except for heart organ recipients who were at highest risk for coronary artery disease with a standardized incidence ratio of 13.12 (10.57-16.29), kidney and liver organ recipients had a ninefold increased risk in developing deep vein thrombosis post-transplant. In conclusion, solid organ transplant patients are at risk of cardiovascular disease, in particular, deep vein thrombosis, which may warrant early identification of high-risk patients in addition to prompt and adequate thromboprophylaxis perioperatively.

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“…15,18–21 Fortunately, UEDVTs are associated with a low incidence of pulmonary embolism both in the general population (6%) 22,23 and after HT (8%–9%). 15,23 …”

Section: Discussionmentioning

confidence: 99%

Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem

Holzhauser

Imamura

Nayak

et al. 2018

Journal of Cardiac Failure

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Background Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Methods We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI). Results A total of 138 patients (55 ± 11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P < .05 for all). Lead implantation time was identified as an independent predictor for RLFs (P < .05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P < .04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI. Conclusion RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach.

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Venous thromboembolism in heart transplant recipients: Incidence, recurrence and predisposing factors

Cited by 30 publications

References 26 publications

Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Cardiovascular disease risk in patients receiving organ transplantation: a national cohort study

Consequences of Retained Defibrillator and Pacemaker Leads After Heart Transplantation—An Underrecognized Problem

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