Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study

Abstract

Venous thromboembolism (VTE) is a frequent complication after solid organ transplantation (SOT) and, specifically, after lung transplantation (LT). The objectives of this study were to evaluate prophylaxis with enoxaparin and to describe risk factors for VTE after LT. We retrospectively reviewed the clinical records of 333 patients who underwent LT in our institution between 2009 and 2014. We compared two consecutive cohorts: one that received enoxaparin only during post-transplant hospital admissions and a second cohort that received 90-day extended prophylaxis with enoxaparin. Cumulative incidence function for competing risk analysis was used to determine incidence of VTE during the first year after transplantation. Risk factors were analyzed using a Cox proportional hazards regression model. The cumulative incidence of VTE was 15.3% (95% CI: 11.6-19.4). Median time from transplant to the event was 40 (p25-p75, 14-112) days. Ninety-day extended prophylaxis did not reduce the incidence of VTE. In this study, the risk factors associated with VTE were male gender and interstitial lung disease. VTE is a major complication after LT, and 90-day extended prophylaxis was not able to prevent it. Large, multicenter, randomized clinical trials should be performed to define the best strategy for preventing VTE.

Heparin-Free Lung Transplantation on Venovenous Extracorporeal Membrane Oxygenation Bridge

“…Accordingly, patients undergoing LuTX are exposed to a high risk of thromboembolism. 10 With our approach, this imbalance of coagulation system toward thromboembolism and consumption coagulopathy is contrasted by preoperative supplementation of fibrinogen and ATIII, prophylactic tranexamic acid, and ECMO circuit substitution whenever early signs of coagulation system activation are detected. Indeed, a fully heparin-coated ECMO circuitry is known to provide sufficient antithrombotic function for limited periods, up to 24-48 hours.…”

Pulmonary Embolism Following Lung Transplantation: Prevention and Management

“…Pharmacologic prophylaxis involves various anticoagulant medications (heparin derivatives, aspirin, novel anticoagulants, warfarin) scheduled prior to the development of VTE to minimize the occurrence. [2][3][4][5][6][7]20,21 The doses of the prophylactic medications are lower than the therapeutic dose to decrease bleeding events while promoting an antithrombotic state. 20,21 Recently, recognition of increased infection and thrombosis with longer indwelling times of CVC has prompted earlier removal of CVCs with a subsequent decrease in VTE.…”

“…[2][3][4][5][6][7]20,21 The doses of the prophylactic medications are lower than the therapeutic dose to decrease bleeding events while promoting an antithrombotic state. 20,21 Recently, recognition of increased infection and thrombosis with longer indwelling times of CVC has prompted earlier removal of CVCs with a subsequent decrease in VTE. [2][3][4][5][6][7] Specific to transplant medicine, sirolimus is no longer commonplace as part of the immunosuppression regimen, partly related to the increased risk of VTE in patients who receive sirolimus as part of their immunosuppressive regimen.…”