Venous thromboembolism in lung transplant recipients real world experience from a high volume center

Zheng, Matthew; Yousef, Ibraheem; Mamary, A.J.; Zhao, Huaqing; McEldrew, J.; Adika, Adam Z.; Shigemura, Norihisa; Cordova, Francis; Criner, G.J.; Mulhall, P.; Galli, J.; Shenoy, Kartik; Brown, James R.; Marchetti, N.; Rali, Parth; Sehgal, Sameep

doi:10.1016/j.healun.2021.07.010

Cited by 10 publications

(23 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is associated with cardiac arrhythmia and right ventricular dysfunction and has an overall mortality rate of up to 10% [10,11]. The reported incidence of thromboembolic complications after LTX is considered higher compared to other cardiothoracic surgeries [12] but varies widely between studies (6-44%) [6,8,[13][14][15]. In our study, as in most of the others, only clinical symptoms prompted further investigation, so thromboembolic events might have been missed.…”

Section: Introductionmentioning

confidence: 66%

“…In our study, as in most of the others, only clinical symptoms prompted further investigation, so thromboembolic events might have been missed. This is supported by studies that implemented a regular screening protocol, where a higher incidence of TE was reported compared to studies without such a protocol [12]. Solid organ transplantation itself is recognized as an independent risk factor for thromboembolic events [16].…”

Section: Introductionmentioning

confidence: 89%

See 1 more Smart Citation

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Moneke

Ögütür

Kalbhenn

et al. 2022

J Thromb Thrombolysis

View full text Add to dashboard Cite

Background Thromboembolism (TE) after lung transplantation (LTX) is associated with increased morbidity and mortality. The aim of this study is to analyze the incidence and outcome of venous and arterial thromboembolic complications and to identify independent risk factors. Patients and methods We retrospectively analyzed the medical records of 221 patients who underwent LTX at our institution between 2002 and 2021. Statistical analysis was performed using SPSS and GraphPad software. Results 74 LTX recipients (33%) developed TE. The 30-days incidence and 12-months incidence were 12% and 23%, respectively. Nearly half of the patients (48%) developed pulmonary embolism, 10% ischemic stroke. Arterial hypertension (p = 0.006), a body mass index (BMI) > 30 (p = 0.006) and diabetes mellitus (p = 0.041) were independent predictors for TE. Moreover, a BMI of > 25 at the time of transplantation was associated with an increased risk for TE (43% vs. 32%, p = 0.035). At the time of LTX, 65% of the patients were older than 55 years. An age > 55 years also correlated with the incidence of TE (p = 0.037) and these patients had reduced overall post-transplant survival when the event occurred within the first postoperative year (59% vs. 72%, p = 0.028). Conclusions The incidence of TE after LTX is high, especially in lung transplant recipients with a BMI > 25 and an age > 55 years as well as cardiovascular risk factors closely associated with the metabolic syndrome. As these patients comprise a growing recipient fraction, intensified research should focus on the risks and benefits of regular screening or a prolonged TE prophylaxis in these patients. Trial registration number DKRS: 00021501.

show abstract

Section: Introductionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 89%

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Moneke

Ögütür

Kalbhenn

et al. 2022

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…Importantly, the development of VTE has been significantly associated with reduced survival following lung transplantation, even with upper extremity or below-the-knee deep venous thrombosis ( 1 , 3 , 4 ). Thus, routine surveillance with screening duplex ultrasound may be warranted in the acute postoperative period ( 1 , 2 ). While inferior vena cava filter insertion may be considered as an adjunct to therapy in these patients, AC provides additional benefit from other thrombotic complications and avoids the procedural risks related to filter placement.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary transplant recipients possess a drastically heightened vulnerability for perioperative thrombotic complications. Estimates have reported that 17-30% of lung transplant recipients develop venous thromboembolism (VTE) by 30 days after transplantation, and VTE incidence rises up to 40-64% by 4 years (1)(2)(3)(4)(5). Early VTE is especially frequent in these patients, with a median time from lung transplantation to VTE diagnosis of 17-20 days (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Estimates have reported that 17–30% of lung transplant recipients develop venous thromboembolism (VTE) by 30 days after transplantation, and VTE incidence rises up to 40–64% by 4 years ( 1 - 5 ). Early VTE is especially frequent in these patients, with a median time from lung transplantation to VTE diagnosis of 17–20 days ( 1 , 2 ). These remarkable rates of thrombotic complications surpass those reported after other surgical procedures, including thoracic surgery (12%) and other types of solid organ transplantation (3–17%) ( 6 - 9 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding and thrombotic complications associated with anticoagulation prior to lung transplantation: a case series

Shepherd¹,

Hachem²,

Witt³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background Scarce data is available on therapeutic anticoagulation (AC) in patients undergoing pulmonary transplantation. We describe our institutional experience with AC-induced coagulopathy in recipients at the time of transplantation and evaluate its impact on posttransplant outcomes. Methods Records of adult patients on therapeutic AC at the time of lung transplantation from January 2014 to July 2021 were reviewed. Administration of preoperative pharmacologic reversal was assessed, with adequate reversal defined as international normalized ratio (INR) ≤1.5. We evaluated the incidence of major bleeding complications [delayed sternal closure, reoperation due to bleeding, chest tube output ≥1,500 cc, ≥4 units of packed red blood cells, ≥4 units of platelets, or ≥5 units of fresh frozen plasma (FFP)], major thrombotic complications [venous thromboembolism (VTE) or other major thrombosis on imaging], and inpatient mortality. Results Of 602 lung transplant recipients, 10 patients taking preoperative warfarin were included in the study. While most patients received pharmacologic reversal preoperatively (n=9, 90%), successful reversal was rarely achieved (n=3, 30%). Inadequate INR reversal was associated with major bleeding events (n=6, 60%). Major thrombotic complications were more frequent (n=7, 70%) than bleeding events. Notably, all fatalities within the cohort (n=2, 20%) were associated with thrombotic, but not bleeding, complications. Conclusions This is the first known report on the incidence and impact of AC-induced coagulopathy in patients undergoing lung transplantation. Major thrombotic events are frequent and associated with high mortality. Routine surveillance and treatment may be warranted.

show abstract

National Trends, Risk Factors, and Outcomes of Acute In-Hospital Stroke Following Lung Transplantation in the United States

Shou¹,

Wilcox²,

Florissi³

et al. 2023

CHEST

View full text Add to dashboard Cite

Venous thromboembolism in lung transplant recipients real world experience from a high volume center

Cited by 10 publications

References 17 publications

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Bleeding and thrombotic complications associated with anticoagulation prior to lung transplantation: a case series

National Trends, Risk Factors, and Outcomes of Acute In-Hospital Stroke Following Lung Transplantation in the United States

Contact Info

Product

Resources

About