title: Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study.
abstract: BACKGROUND
  The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.
  
  
  OBJECTIVE
  Pre-HT coagulopathy is associated with increased in-hospital mortality.
  
  
  METHODS
  Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics.
  
  
  RESULTS
  The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008).
  
  
  CONCLUSIONS
  In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
authors: Department of Medicine, New York Medical College, Valhalla, New York.
authors: Marjan
authors: M
authors: Mujib
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Neel
authors: N
authors: Khanna
authors: Department of Medicine, Flushing Hospital Medical Center, Flushing, New York.
authors: Nabila K
authors: NK
authors: Mazumder
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Wilbert S
authors: WS
authors: Aronow
authors: Department of Medicine, New York Medical College, Valhalla, New York.
authors: Dhaval
authors: D
authors: Kolte
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Sahil
authors: S
authors: Khera
authors: Department of Medicine, Division of Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Chandrasekar
authors: C
authors: Palaniswamy
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Diwakar
authors: D
authors: Jain
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Gregg M
authors: GM
authors: Lanier
authors: Department of Medicine, New York Medical College, Valhalla, New York.
authors: Sachin
authors: S
authors: Sule
authors: Department of Medicine, Washington DC VA Medical Center, Washington, DC.
authors: Ali
authors: A
authors: Ahmed
authors: Division of Cardiology, University of Washington, Seattle, Washington.
authors: Wayne C
authors: WC
authors: Levy
authors: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Sumanth D
authors: SD
authors: Prabhu
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Howard A
authors: HA
authors: Cooper
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Julio A
authors: JA
authors: Panza
authors: Division of Cardiology, New York Medical College, Valhalla, New York.
authors: Alan L
authors: AL
authors: Gass
authors: Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D016027:Heart Transplantation; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012494:Sampling Studies