Limited Effect of Prevention Strategies on Incidence of Clinically Detectable Venous Thromboembolism After Lung Transplantation.

Autor: Marshall S; Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts., Tsveybel K; Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts., Boukedes S; Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts., Chepuri R; Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin., Coppolino A; Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts., El-Chemaly S; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Hartigan P; Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts., Kennedy J; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Keshk M; Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts., Klibaner-Schiff E; Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts., Lee S; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts., Mallidi H; Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts., Sharma N; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts., Thaniyavarn T; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts., Young J; Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, Veterans Affairs Boston Health care System, Boston, Massachusetts., Townsend K; Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts., Goldberg H; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: hjgoldberg@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2023 Nov; Vol. 55 (9), pp. 2191-2196. Date of Electronic Publication: 2023 Oct 04.
DOI: 10.1016/j.transproceed.2023.06.015
Abstrakt: Background: Thromboembolic complications are common post-lung transplant, leading to significant morbidity. We instituted multiple interventions because of an observed 36.8% incidence of venous thromboembolism (VTE) (Incidence rate (IR) 5.74/1000 pt days) in our recipients.
Methods: Our initiative commenced January 2015 with enoxaparin initiation within 6-8 hours of intensive care unit arrival and continuation for 4-6 weeks. We evaluated the IR of VTE in lung transplant recipients within 90 days of transplant. In 2017, the protocol was modified to extend the time to initiation of prophylaxis to within 72 hours of ICU arrival. In 2019, we further amended our intraoperative vascular access strategy.
Results: Eighteen of 26 lung transplant recipients (LTR) met inclusion criteria in the 2015 cohort. Six of 18 (33.3%) developed VTE, 50% of which were upper extremity (UE), line associated. Fifty two of 75 LTR were eligible for enoxaparin prophylaxis in the 2017 cohort. Fifteen of 52 subjects (28.8%) developed VTE, 77.8% of which were UE and line associated. Despite improved adherence in 2017, there was little change in VTE IR (3.90/1000 pt days compared with 3.85/1000 pt days). Twenty six of 43 LTR met protocol inclusion criteria in the 2019 cohort. Ten subjects (38.5%) developed VTE, 67% of which were UE and line associated (IR 5.18/1000 pt days).
Conclusion: Our prospective study found that LTR remain at high risk for VTE despite aggressive prophylaxis with 4-6 weeks of enoxaparin and adjustment of vascular access approach. Alternative interventions should be investigated to minimize VTE development in this vulnerable population.
Competing Interests: Declaration of Competing Interest Souheil El-Chemaly is employed by Sanofi, Inc. No other authors have relevant conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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