A single-center experience of preemptive anticoagulation for patients with risk factors for allograft thrombosis in renal transplantation.
OBJECTIVE
to review our single-center experience of preemptive anticoagulation for the prevention of allograft thrombosis in patients with hypercoagulable states.


METHODS
this is a retrospective cohort study. Included subjects were first-time kidney allograft recipients transplanted between 2003 and 2007 at a single center, with hypercoagulable states: prior venous thromboembolism, multiple vascular access thromboses, or identifiable thrombophilia. The predictor variable was preemptive anticoagulation and outcome variable was allograft thrombosis. Other risk factors for allograft thrombosis, characteristics of transplantation, and hemorrhagic complications were also examined.


RESULTS
among this high-risk cohort (n = 48), 16 received preemptive anticoagulation and 32 did not. The anticoagulated group included significantly more subjects with identifiable thrombophilia (50.0% vs. 0%; p < 0.001). One subject (6.3%) in the anticoagulated group and 6 (18.8%) without anticoagulation developed allograft thrombosis (p = 0.40). A perinephric hematoma was observed in 5 (31.3%) and 2 (6.3%) with and without anticoagulation, respectively (p = 0.03).


CONCLUSIONS
preemptive anticoagulation was associated with a non-significant trend towards decreased allograft thrombosis. It may be associated with increased risk of hemorrhage and should be considered cautiously in high-risk patients.
Murashima
M
M
Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. murashimam@aol.com
Konkle
B A
BA
Bloom
R D
RD
Sood
S L
SL
Grossman
R A
RA
Brunelli
S M
SM
Stein
S H
SH
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010414:Pennsylvania; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000925:Anticoagulants