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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Farr MA, Sayer GT, Uriel N, Takayama H, Naka Y, Takeda K. Deep vein thrombosis and pulmonary embolism after heart transplantation. Clin Transplant 2022; 36:e14705. [PMID: 35545895 DOI: 10.1111/ctr.14705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important and serious postoperative complication after heart transplantation. We sought to characterize in-hospital VTE after heart transplantation and its association with clinical outcomes. METHOD Adult (≧18 years) patients undergoing heart transplantation from 2015 to 2019 at our center were retrospectively reviewed. Post-transplant VTE was defined as newly diagnosed venous system thrombus by imaging studies. RESULTS There were 254 patients. The cohort's median age was 55 years. A total of 61 patients were diagnosed with VTE, including 1 with right atrial thrombus, 54 with upper extremity DVT in which one patient subsequently developed PE, 4 with lower extremity DVT, and 2 with upper and lower extremity DVT. The cumulative incidence of VTE was 42% at 60-days of post heart transplant. Patients with VTE had longer hospital stay (p<0.001), higher in-hospital mortality (p = 0.010), and worse 5-year survival (p = 0.009). On the multivariable Cox analysis, history of DVT/PE and intubation for more than 3 days were associated with an increased risk of in hospital VTE. CONCLUSION The incidence of VTE in heart transplant recipients is high. Post-transplant surveillance, and appropriate preventive measures and treatment strategies after diagnosis are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, New York, USA.,Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
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Rodriguez ER, Santos-Martins C, Tan CD. Pathology of cardiac transplantation. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Anticoagulation Reversal and Risk of Thromboembolic Events Among Heart Transplant Recipients Bridged with Durable Mechanical Circulatory Support Devices. ASAIO J 2019; 65:649-655. [DOI: 10.1097/mat.0000000000000866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Lichvar AB, Moore CA, Ensor CR, McDyer JF, Teuteberg JJ, Shullo MA. Evaluation of Direct Oral Anticoagulation Therapy in Heart and Lung Transplant Recipients. Prog Transplant 2018; 26:263-9. [PMID: 27597772 DOI: 10.1177/1526924816661951] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT Anticoagulation therapy is common in thoracic transplant recipients. Direct oral anticoagulants (DOACs) are alternatives to warfarin therapy, but characterization of their use in solid organ transplant is absent. OBJECTIVE The primary objective of this study was to describe a thoracic transplant patient population initiated on DOAC therapy. Secondary objectives were to assess adverse reactions, venous thromboembolism (VTE) recurrence, and drug-drug interactions during DOAC therapy. STUDY DESIGN Single-center retrospective cohort study. SETTING A tertiary care medical center including inpatient hospitalization and outpatient transplant clinic visits. PATIENTS Thoracic transplant recipients who were initiated on DOACs between May 1, 2011, and March 1, 2015, at the University of Pittsburgh Medical Center were included. RESULTS A total of 37 patients were included in the analysis. A majority of the patients were lung transplant recipients (86.4%) with a median age of 60.7 years. Twenty-eight patients had a history of VTE. The primary indication for DOAC initiation was VTE (86.5%). Rivaroxaban (78.4%) was the most commonly utilized agent. Dose reductions for major drug interactions (37.8%), renal insufficiency (10.8%), or both (8.1%) occurred within the study. Two patients had breakthrough VTE during DOAC therapy. Eight bleeding events were reported in the cohort, one of which was considered a major bleed. There was no difference in the incidence of bleeding in patients with drug-drug interactions and without drug-drug interactions during DOAC therapy (26.0% vs 7.1%, P = .154). CONCLUSION Direct oral anticoagulant therapy was well tolerated by thoracic transplant recipients. Drug interactions and renal dose adjustments were common.
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Affiliation(s)
- Alicia B Lichvar
- Division of Transplantation, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Cody A Moore
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Christopher R Ensor
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John F McDyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey J Teuteberg
- School of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael A Shullo
- School of Pharmacy, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Sáez-Giménez B, Berastegui C, Sintes H, Perez-Miranda J, Figueredo A, López Meseguer M, Monforte V, Bravo C, Santamaría A, Ramon MA, Gómez-Ollés S, Roman A. Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study. Transpl Int 2017; 30:1266-1274. [DOI: 10.1111/tri.13021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/24/2017] [Accepted: 07/31/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Berta Sáez-Giménez
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Cristina Berastegui
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Helena Sintes
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Javier Perez-Miranda
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Ana Figueredo
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Manuel López Meseguer
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Víctor Monforte
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Carlos Bravo
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Amparo Santamaría
- Hemostasis and Thrombosis Unit; Department of Hematology; Hospital Universitari Vall d'Hebrón; Barcelona Spain
| | - Maria Antonia Ramon
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Susana Gómez-Ollés
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Antonio Roman
- Pulmonology Service, Lung Transplant Program; Hospital Universitari Vall d'Hebrón; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
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Acampa M, Lazzerini PE, Guideri F, Tassi R, Martini G. Ischemic Stroke after Heart Transplantation. J Stroke 2016; 18:157-68. [PMID: 26915504 PMCID: PMC4901943 DOI: 10.5853/jos.2015.01599] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/13/2015] [Accepted: 01/04/2016] [Indexed: 12/16/2022] Open
Abstract
Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%). Clinically, ischemic stroke is manifested by the appearance of focal neurologic deficits, although sometimes a stroke may be silent or manifests itself by the appearance of encephalopathy, reflecting a diffuse brain disorder. Ischemic stroke subtypes distribution in perioperative and postoperative period after OHT is very different from classical distribution, with different pathogenic mechanisms. Infact, ischemic stroke may be caused by less common and unusual mechanisms, linked to surgical procedures and to postoperative inflammation, peculiar to this group of patients. However, many strokes (40%) occur without a well-defined etiology (cryptogenic strokes). A silent atrial fibrillation (AF) may play a role in pathogenesis of these strokes and P wave dispersion may represent a predictor of AF. In OHT patients, P wave dispersion correlates with homocysteine plasma levels and hyperhomocysteinemia could play a role in the pathogenesis of these strokes with multiple mechanisms increasing the risk of AF. In conclusion, stroke after heart transplantation represents a complication with considerable impact not only on mortality but also on subsequent poor functional outcome.
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Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci, Siena, Italy
| | - Francesca Guideri
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
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Tan C, Halushka M, Rodriguez E. Pathology of Cardiac Transplantation. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Deep vein thrombosis and pulmonary embolism after solid organ transplantation: an unresolved problem. Transplant Rev (Orlando) 2015; 29:85-92. [DOI: 10.1016/j.trre.2014.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 01/15/2023]
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Dolapoglu A, Beketaev I. Venous thromboembolism in heart transplantation: Should we consider genetic predisposition? J Heart Lung Transplant 2015; 34:756-7. [PMID: 25638298 DOI: 10.1016/j.healun.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Ilimbek Beketaev
- Center for Stem Cell Engineering, Texas Heart Institute, Houston, Texas
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Khansa I, Colakoglu S, Tomich DC, Nguyen MD, Lee BT. Factor V Leiden associated with flap loss in microsurgical breast reconstruction. Microsurgery 2011; 31:409-12. [DOI: 10.1002/micr.20879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/13/2010] [Indexed: 11/07/2022]
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