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Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are surgical complications estimated to occur in 5% to 10% of patients. There are limited data regarding DVT/PE in the early postoperative period in liver transplant patients. The aim of this study is to determine risk factors that influence the...

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Autores principales: Yip, James, Bruno, David A., Burmeister, Charlotte, Kazimi, Marwan, Yoshida, Atsushi, Abouljoud, Marwan S., Schnickel, Gabriel T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946512/
https://www.ncbi.nlm.nih.gov/pubmed/27500259
http://dx.doi.org/10.1097/TXD.0000000000000578
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author Yip, James
Bruno, David A.
Burmeister, Charlotte
Kazimi, Marwan
Yoshida, Atsushi
Abouljoud, Marwan S.
Schnickel, Gabriel T.
author_facet Yip, James
Bruno, David A.
Burmeister, Charlotte
Kazimi, Marwan
Yoshida, Atsushi
Abouljoud, Marwan S.
Schnickel, Gabriel T.
author_sort Yip, James
collection PubMed
description Deep vein thrombosis (DVT) and pulmonary embolism (PE) are surgical complications estimated to occur in 5% to 10% of patients. There are limited data regarding DVT/PE in the early postoperative period in liver transplant patients. The aim of this study is to determine risk factors that influence the incidence of DVT/PE and the effectiveness of prophylaxis. METHODS: We reviewed the records of 999 patients who underwent initial liver transplant between January 2000 and June 2012 at Henry Ford Hospital. In 2011, a standardized prophylactic regimen using subcutaneous (SQ) heparin was initiated. All patients that developed either upper/lower extremity DVT or PE within the first 30 days of transplant formed the cohort of this study. RESULTS: On multivariate analysis, only peripherally inserted central catheter (PICC) placement and SQ heparin were associated with DVT/PE. In patients receiving heparin, 3 (1.0%) had DVT/PE versus 25 (3.5%) who did not receive heparin (P = 0.03). Sixteen (6.9%) patients that had a PICC developed DVT/PE compared with 12 (1.6%) patients without a PICC (P < 0.001). In the heparin group, DVT/PE with PICC was reduced to 3 (3.0%) versus 13 (9.9%) in those with a PICC and did not receive heparin (P = 0.03). Mean time from transplant to DVT/PE diagnosis was 12.3 days. Length of hospitalization was significantly longer in patients who developed DVT/PE (18.5 vs 10.0 days, P < 0.001). CONCLUSIONS: In this study, we demonstrated that PICC placement significantly increases the likelihood of DVT/PE in liver transplant recipients. Prophylactic SQ heparin effectively reduced DVT/PE events in this patient population.
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spelling pubmed-49465122016-08-05 Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention Yip, James Bruno, David A. Burmeister, Charlotte Kazimi, Marwan Yoshida, Atsushi Abouljoud, Marwan S. Schnickel, Gabriel T. Transplant Direct Liver Transplantation Deep vein thrombosis (DVT) and pulmonary embolism (PE) are surgical complications estimated to occur in 5% to 10% of patients. There are limited data regarding DVT/PE in the early postoperative period in liver transplant patients. The aim of this study is to determine risk factors that influence the incidence of DVT/PE and the effectiveness of prophylaxis. METHODS: We reviewed the records of 999 patients who underwent initial liver transplant between January 2000 and June 2012 at Henry Ford Hospital. In 2011, a standardized prophylactic regimen using subcutaneous (SQ) heparin was initiated. All patients that developed either upper/lower extremity DVT or PE within the first 30 days of transplant formed the cohort of this study. RESULTS: On multivariate analysis, only peripherally inserted central catheter (PICC) placement and SQ heparin were associated with DVT/PE. In patients receiving heparin, 3 (1.0%) had DVT/PE versus 25 (3.5%) who did not receive heparin (P = 0.03). Sixteen (6.9%) patients that had a PICC developed DVT/PE compared with 12 (1.6%) patients without a PICC (P < 0.001). In the heparin group, DVT/PE with PICC was reduced to 3 (3.0%) versus 13 (9.9%) in those with a PICC and did not receive heparin (P = 0.03). Mean time from transplant to DVT/PE diagnosis was 12.3 days. Length of hospitalization was significantly longer in patients who developed DVT/PE (18.5 vs 10.0 days, P < 0.001). CONCLUSIONS: In this study, we demonstrated that PICC placement significantly increases the likelihood of DVT/PE in liver transplant recipients. Prophylactic SQ heparin effectively reduced DVT/PE events in this patient population. Lippincott Williams & Wilkins 2016-03-01 /pmc/articles/PMC4946512/ /pubmed/27500259 http://dx.doi.org/10.1097/TXD.0000000000000578 Text en Copyright © 2016 The Authors. Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle Liver Transplantation
Yip, James
Bruno, David A.
Burmeister, Charlotte
Kazimi, Marwan
Yoshida, Atsushi
Abouljoud, Marwan S.
Schnickel, Gabriel T.
Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title_full Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title_fullStr Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title_full_unstemmed Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title_short Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention
title_sort deep vein thrombosis and pulmonary embolism in liver transplant patients: risks and prevention
topic Liver Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946512/
https://www.ncbi.nlm.nih.gov/pubmed/27500259
http://dx.doi.org/10.1097/TXD.0000000000000578
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