Utility of Oral Anticoagulants as Prophylaxis of Recurrent Portal Thrombosis after Liver Transplantation

Sánchez-Ocaña, Ramón; Tejedor-Tejada, Javier; Cimavilla-Roman, M; Benito-Sanz, M de; Asensio-Díaz, E.; Barrera-Rebollo, A.; Pérez-Saborido, B.; García-Pajares, Félix; Almohalla, C.; Sánchez-Antolín, Gloria

doi:10.1016/j.transproceed.2018.07.014

Cited by 11 publications

(22 citation statements)

References 12 publications

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“…We found that patients with incidental PVT had more thromboses in the liver graft early after surgery. A higher incidence of postoperative PVT in patients with previous PVT was reported by our group 28 and corroborated by others more recently 29 …”

Section: Discussionsupporting

confidence: 90%

Is antivitamin K reversal required in patients with cirrhosis undergoing liver transplantation?

Martinez

Ruíz

et al. 2021

Transfusion

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Background Antivitamin K agent (AVK) reversal in patients with cirrhosis awaiting liver transplantation (LT) is not defined in guidelines. We investigated the effect of reversion with prothrombin complex concentrate (PCC) on intraoperative transfusion, bleeding, and safety in LT patients on AVK. Study design and methods In 511 patients undergoing LT, we identified 25 patients treated with AVK (AVK group) and 13 patients with incidental portal vein thrombosis (PVT) without AVK (incidental PVT group). Fifty patients who underwent LT without PVT or AVK matched by age, model for end stage of liver disease (MELD), body mass index (BMI), and cirrhosis etiology were selected as the control group. Results There were no significant differences between the three groups in intraoperative blood loss, transfusion, and postoperative bleeding. In the AVK group, there were no differences between patients who received PCC and those who did not in intraoperative blood loss, red blood cells, fibrinogen, and platelet transfusion, or postoperative bleeding. PCC use had no effect on RBC transfusion in patients who had international normalized ratio or clotting time above versus below median values of the two parameters at baseline (2.3 and 103 s, respectively). No thrombotic events were detected in patients who received PCC. Discussion These data suggest that systematic administration of PCC to revert AVK prior to LT should be reconsidered.

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Section: Discussionsupporting

confidence: 90%

Is antivitamin K reversal required in patients with cirrhosis undergoing liver transplantation?

Martinez

Ruíz

et al. 2021

Transfusion

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“…PVT incidence among cirrhotic patients has been reported to be as high as 5% to 26% 1‐4 and it is reported to be discovered during the LT procedure in 30% to 50% of cases 8,14 15 a decrease in the portal blood velocity, 16 and the development of collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, most liver transplantation centers have developed their own protocols, which mostly consist in administering tAC for a period of 3 to 6 months, 6‐8 although it can increase the incidence of bleeding events among patients already considered at increased risk during the early postoperative course 9 …”

Section: Introductionmentioning

confidence: 99%

“…Consequently, most liver transplantation centers have developed their own protocols, which mostly consist in administering tAC for a period of 3 to 6 months, [6][7][8] although it can increase the incidence of bleeding events among patients already considered at increased risk during the early postoperative course. 9 The aim of the present study was, in two tertiary high-volume liver transplantation centers, to evaluate the usefulness of tAC administered after LT in the prevention of PVT recurrence at 1 year after the procedure, and any potential side effects.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic anticoagulation after liver transplantation is not useful among patients with pre‐transplant Yerdel‐grade I/II portal vein thrombosis: A two‐center retrospective study

Bos

Blondeau

Wouters

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Portal vein thrombosis (PVT) is no longer a contraindication for liver transplantation (LT). While therapeutic anticoagulation (tAC) is recommended during the waiting period, there is no evidence for its usefulness in the prevention of PVT recurrence after LT. Objectives The aim of our study was to evaluate the role of tAC post‐LT in the prevention of PVT recurrence. Patients/methods All adult LTs performed in two high‐volume centers between 2003 and 2018 were retrospectively analysed. Only patients with PVT classified as Yerdel grade I or II and with standard portal reconstruction were included. PVT recurrence and tAC‐associated morbidity within 1 year were compared between patients receiving tAC or not. Results During the study period, of 2612 LTs performed, 235 (9%) patients with PVT were included; 113 patients (48.1%) received post‐LT tAC (tAC group) while 122 (51.9%) did not (non‐tAC group). The incidence of bleeding events was significantly higher in the tAC group (26 [23%] vs. 5 [4.1%], P < .01) and the initial hospitalization duration was longer (21 vs. 17.5 days, P < .01). Within the first year, PVT recurrence was observed for 9 (3.8%) patients without any difference between the tAC and non‐tAC groups (6 [5.1%] vs. 3 [2.5%], P = .39). The only identified risk factor for PVT recurrence was the recipients’ age (odds ratio= 0.94, P = .03). Graft (P = .11) and patient (P = .44) survival were similar between the two groups. Conclusion Therapeutic anticoagulation is not necessary in the prevention of grade I/II PVT recurrence and is associated with higher morbidity and longer hospital stay.

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“…Both meta-analysis and retrospective studies have demonstrated safety and efficacy of LMWH and VKA treatment for PVT. 48 groups treated with LMWH, VKA or DOACs. Uniquely, this study used meta-regression analysis to assess effect based upon the patient's CTP classification and found the severity of disease did not appear to influence outcomes.…”

Section: Direct Oral Anti-coagulants In Liver Transplantation Patientsmentioning

confidence: 99%

2020 Clinical Update in Liver Transplantation

Wilke

Fremming

Brown

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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The gold standard treatment of end-stage liver disease continues to be liver transplantation (LT). The challenges of LT require skilled anesthesiologists to anticipate physiologic changes associated with end-stage liver disease (ESLD) as well as surgical considerations that affect multiple organ systems. While on the waiting list, patients may be placed new anticoagulation medications that can confound already complex coagulopathy in LT patients. Pain management is often an afterthought for such a complex procedure but appropriate medications can help control pain while limiting opioid medications. Surgical stress and medications for immunosuppression can affect perioperative glucose management in ways that have implications for patient and graft survival. 2020 provided a new challenge for anesthesiologist, the COVID-19 pandemic. The uncertainty of the novel respiratory virus challenged providers in beyond just LT patients.

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Utility of Oral Anticoagulants as Prophylaxis of Recurrent Portal Thrombosis after Liver Transplantation

Cited by 11 publications

References 12 publications

Is antivitamin K reversal required in patients with cirrhosis undergoing liver transplantation?

Is antivitamin K reversal required in patients with cirrhosis undergoing liver transplantation?

Therapeutic anticoagulation after liver transplantation is not useful among patients with pre‐transplant Yerdel‐grade I/II portal vein thrombosis: A two‐center retrospective study

2020 Clinical Update in Liver Transplantation

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