Is there a procoagulant state long-term after lung transplantation? A prospective study

Published on Nov 1, 2021in Respiratory Medicine3.415
· DOI :10.1016/J.RMED.2021.106584
Berta Sáez-Giménez5
Estimated H-index: 5
(Autonomous University of Barcelona),
David Clofent2
Estimated H-index: 2
(Autonomous University of Barcelona)
+ 11 AuthorsVictoria E. Ruiz10
Estimated H-index: 10
(Autonomous University of Barcelona)
Source
Abstract
ABSTRACT null null Background null Venous thromboembolism (VTE) is a major complication after lung transplantation (LT). However, its pathophysiology remains unknown, and coagulation profiles have yet to be described. null null null Objective null The aim of this study was to longitudinally assess coagulation status after LT. null null null Methods null We performed a prospective study and described the coagulation profiles of 48 patients at 5 different time-points: before LT and at 24-72 hours, 2 weeks, 4 months, and 1 year after LT. null null null Results null At baseline, almost all analyzed coagulation factors were within the normal range, except for FVIII, which was above the normal range. Von Willebrand factor (vWF) and FVIII were increased after LT and remained high at 1 year after transplantation. The cumulative incidence of VTE was 22.9%. Patients who developed VTE had higher FVIII activity 2 weeks after LT. null null null Conclusions null This is the first study to describe coagulation profiles up to 1 year after LT. We show that most markers of a procoagulant state normalize at 2 weeks after LT, but that values of FVIII and vWF remain abnormal at 1 year. This problem has received little attention in the literature. Larger studies are necessary to confirm the results and to design appropriate prophylactic strategies.
References43
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#1Berta Sáez-Giménez (Autonomous University of Barcelona)H-Index: 5
#2Cristina Berastegui (Autonomous University of Barcelona)H-Index: 14
Last. Antonio Roman (Autonomous University of Barcelona)H-Index: 29
view all 12 authors...
Background 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. Methods We retrospectively reviewed the clinical records of 333 patients who underwent LT in our institution between 2009 and 2014. We compared 2 consecutive cohorts, one that received enoxaparin only during post-transpl...
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#1Jinbeom Cho (Catholic University of Korea)H-Index: 6
#2Kang Woong Jun (Catholic University of Korea)H-Index: 4
Last. Ji Il Kim (Catholic University of Korea)H-Index: 10
view all 6 authors...
Background Patients with chronic kidney disease (CKD) tend to experience both thrombotic and hemorrhagic complications; however, the pathophysiology remains unclear. This study aimed to identify the underlying mechanisms and characteristics of hemostatic problems in patients with CKD and to demonstrate the role of kidney transplantation (KT) in correcting these hemostatic abnormalities. Methods In this retrospective observational study, 557 KT recipients who did not receive peri-operative plasma...
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#1Sandesh Parajuli (UW: University of Wisconsin-Madison)H-Index: 16
#2Joseph B. Lockridge (OHSU: Oregon Health & Science University)H-Index: 3
Last. Jody L. Kujovich (OHSU: Oregon Health & Science University)H-Index: 10
view all 5 authors...
AbstractThrombosis remains an important complication after kidney transplantation. Outcomes for graft and deep vein thrombosis are not favorable. The majority of early kidney transplant failure in adults is due to allograft thrombosis. Risk stratification, early diagnosis, and appropriate interventi
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#1Berta Sáez-Giménez (ISCIII: Carlos III Health Institute)H-Index: 5
#2Cristina Berastegui (ISCIII: Carlos III Health Institute)H-Index: 14
Last. Antonio Román (ISCIII: Carlos III Health Institute)H-Index: 12
view all 8 authors...
Venous thromboembolism (VTE) is a major complication after solid organ transplantation (SOT), with an incidence that ranges from 2 to 34%. Besides genetic risk factors such as inherited thrombophilia, other specific risk factors for VTE in SOT recipients include impairment of fibrinolysis produced by corticosteroids, in vitro procoagulant effects of calcineurin inhibitors, endothelial damage due to cytomegalovirus infection, and specific surgical factors. Prevention strategies have not been syst...
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#1Karin Ruitenbeek (UG: University of Groningen)H-Index: 4
Last. Ton LismanH-Index: 72
view all 9 authors...
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#1Vidya Navaratnam (University of Nottingham)H-Index: 15
#2Andrew W. Fogarty (University of Nottingham)H-Index: 32
Last. Richard Hubbard (University of Nottingham)H-Index: 96
view all 10 authors...
Background Laboratory studies suggest that the clotting cascade is activated in fibrotic lungs. Since humans vary in their tendency to clot due to a variety of inherited or acquired defects, we investigated whether a prothrombotic state increases the chance of developing idiopathic pulmonary fibrosis (IPF) and/or worsens the prognosis of IPF. Methods We recruited 211 incident cases of IPF and 256 age- and sex-matched general population controls and collected data on medical history, medication, ...
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#1Freeha Arshad (UMCG: University Medical Center Groningen)H-Index: 6
#2Ton Lisman (UMCG: University Medical Center Groningen)H-Index: 72
Last. Robert J. Porte (UMCG: University Medical Center Groningen)H-Index: 83
view all 3 authors...
Traditionally, perioperative bleeding complications were a major concern during orthotopic liver transplantation, but a tremendous decline in transfusion requirements has been reported over the last decade. In recent years, there has been an increasing awareness towards perioperative thrombotic complications, including liver vessel thrombosis, and systemic venous and arterial thromboembolic events. Whereas a number of these thrombotic complications were previously categorized as surgical complic...
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#1Imre Noth (U of C: University of Chicago)H-Index: 45
#2Kevin J. Anstrom (Duke University)H-Index: 81
Last. Mitchell A. Olman (Cleveland Clinic)H-Index: 32
view all 8 authors...
Rationale: Animal and human studies support the importance of the coagulation cascade in pulmonary fibrosis.Objectives: In a cohort of subjects with progressive idiopathic pulmonary fibrosis (IPF), we tested the hypothesis that treatment with warfarin at recognized therapeutic doses would reduce rates of mortality, hospitalization, and declines in FVC.Methods: This was a double-blind, randomized, placebo-controlled trial of warfarin targeting an international normalized ratio of 2.0 to 3.0 in pa...
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#1Greg J. McKenna (Baylor University Medical Center)H-Index: 16
#2James F. TrotterH-Index: 54
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#1Vivek N. Ahya (UPenn: University of Pennsylvania)H-Index: 6
#2Pamela J. McShane (U of C: University of Chicago)H-Index: 7
Last. Sangeeta Bhorade (U of C: University of Chicago)H-Index: 34
view all 17 authors...
Background Sirolimus (rapamycin) is a potent anti-proliferative agent with immunosuppressive properties that is increasingly being used in solid-organ and hematopoietic stem cell transplantation. In addition, this drug is being investigated for treatment of a broad range of disorders, including cardiovascular disease, malignancies, tuberous sclerosis, and lymphangeioleiomyomatosis. In this study, we found an increased risk of venous thromboembolism (VTE) in lung transplant recipients treated wit...
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