Shepherd Hailey M, Hachem Ramsey R, Witt Chad A, Guillamet Rodrigo V, Byers Derek E, Kozower Benjamin D, Meyers Bryan F, Takahashi Tsuyoshi, Patterson G Alexander, Puri Varun, Kreisel Daniel, Nava Ruben G
Departments of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Departments of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
J Thorac Dis. 2022 Aug;14(8):2917-2926. doi: 10.21037/jtd-22-300.
Scarce data is available on therapeutic anticoagulation (AC) in patients undergoing pulmonary transplantation. We describe our institutional experience with AC-induced coagulopathy in recipients at the time of transplantation and evaluate its impact on posttransplant outcomes.
Records of adult patients on therapeutic AC at the time of lung transplantation from January 2014 to July 2021 were reviewed. Administration of preoperative pharmacologic reversal was assessed, with adequate reversal defined as international normalized ratio (INR) ≤1.5. We evaluated the incidence of major bleeding complications [delayed sternal closure, reoperation due to bleeding, chest tube output ≥1,500 cc, ≥4 units of packed red blood cells, ≥4 units of platelets, or ≥5 units of fresh frozen plasma (FFP)], major thrombotic complications [venous thromboembolism (VTE) or other major thrombosis on imaging], and inpatient mortality.
Of 602 lung transplant recipients, 10 patients taking preoperative warfarin were included in the study. While most patients received pharmacologic reversal preoperatively (n=9, 90%), successful reversal was rarely achieved (n=3, 30%). Inadequate INR reversal was associated with major bleeding events (n=6, 60%). Major thrombotic complications were more frequent (n=7, 70%) than bleeding events. Notably, all fatalities within the cohort (n=2, 20%) were associated with thrombotic, but not bleeding, complications.
This is the first known report on the incidence and impact of AC-induced coagulopathy in patients undergoing lung transplantation. Major thrombotic events are frequent and associated with high mortality. Routine surveillance and treatment may be warranted.
关于肺移植患者治疗性抗凝（AC）的可用数据稀缺。我们描述了我们机构在移植时接受AC治疗的受者中AC诱导的凝血病的经验，并评估其对移植后结局的影响。
回顾了2014年1月至2021年7月期间接受肺移植时接受治疗性AC的成年患者的记录。评估术前药物逆转的使用情况，将充分逆转定义为国际标准化比值（INR）≤1.5。我们评估了主要出血并发症（延迟胸骨闭合、因出血再次手术、胸腔引流管引流量≥1500 cc、≥4单位浓缩红细胞、≥4单位血小板或≥5单位新鲜冰冻血浆（FFP））、主要血栓形成并发症（静脉血栓栓塞（VTE）或影像学上的其他主要血栓形成）和住院死亡率的发生率。
在602例肺移植受者中，10例术前服用华法林的患者被纳入研究。虽然大多数患者术前接受了药物逆转（n = 9，90%），但很少能成功逆转（n = 3，30%）。INR逆转不充分与主要出血事件相关（n = 6，60%）。主要血栓形成并发症比出血事件更频繁（n = 7，70%）。值得注意的是，队列中的所有死亡（n = 2，20%）均与血栓形成而非出血并发症相关。
这是关于肺移植患者AC诱导的凝血病的发生率和影响的首次已知报告。主要血栓形成事件频繁且与高死亡率相关。可能需要进行常规监测和治疗。
