Original Research
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: Venous thromboembolism (VTE) and bleeding events (BE) represent significant challenges to care for post-liver transplant patients as both are associated with poorer outcomes. It is not fully concluded whether giving pharmacologic thromboprophylaxis universally after liver transplantation to prevent VTE outweighs the risk of developing BE.
Research Question or Hypothesis: What are the incidences of VTE and BE in adult post-liver transplant patients?
Study Design: A single-centered, retrospective review of medical records
Methods: Medical records of 361 adult liver transplant patients from January 2014-December 2019 were reviewed. Patients were excluded if they were on anticoagulants before the transplant. The medical records were reviewed for VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and BE within 30 days of transplant. Risk factors for VTE and BE such as malignancy, hyper/hypocoagulable disorders, etc., as well as anticoagulant usage, were collected. Descriptive statistics were used for the analysis.
Results: 343 medical records were included. The majority were male (85.1%) and Caucasian (62.7%). The most common indication for transplant was alcoholism (27.6%). The average MELD and MELD-NA scores were 21 and 22. Six patients (1.7%) experienced a VTE within the 30 days post-liver transplant, including 1 DVT and 5 PE. The average time from transplant to VTE diagnosis was 5.7 days (SD = 6.8). Among the 6 patients with VTE, 4 initiated anticoagulants for VTE treatment and 2 did not due to massive PE resulting in death. Sixteen (4.7%) patients were identified as symptomatic bleeding within 30 days and 6 (37.5%) of those were on VTE prophylaxis. The average time to a BE was 8.3 days (SD = 9.3).
Conclusion: VTE occurred infrequently early post-transplant with a rate of 1.7%, while BE at 4.7%. Given the numerically higher incidence of BE than VTE post-liver transplant, our current practice of an individualized approach to VTE prophylaxis based on patients’ risk factors is justified.
Presenting Author
Peter Hinchey PharmD CandidateUniversity of Nebraska College of Pharmacy
Authors
Mary Leick PharmD, BCPS, BCTXP
Nebraska Medicine
Hong Li BS
University of Nebraska Medical Center
Carrie McAdam-Marx MCSI, PhD, RPh
University of Nebraska Medical Center
Haoran Yang PharmD
Zhongshan Hospital, Fudan University