Venous thromboembolism following hematopoietic stem cell transplantation-a systematic review and meta-analysis.
Venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplantation (HSCT). Graft-versus-host disease (GVHD) is another complication of HSCT that may modify the risk of VTE. Our objective was to explore the incidence of VTE (deep venous thrombosis and pulmonary embolism) following HSCT and to evaluate its association with GVHD. A comprehensive search of Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus was conducted to search for both retrospective and prospective HSCT studies which had reported VTE. Random-effects meta-analysis was used to pool incidence rates. We included 17 studies reporting on allogeneic- and 10 on autologous-HSCT; enrolling 6693 patients; of which 5 were randomized. The overall incidence of VTE after HSCT was 5 % (4-7 %). Incidence in allogeneic-HSCT was 4 % (2-6 %) and in autologous-HSCT was 4 % (1-15 %). Eleven and nine studies reported data on acute and chronic GVHD, respectively. The incidence of VTE in chronic GVHD was 35 % (20-54 %), whereas in acute GVHD it was 47 % (32-62 %). Based on the results of this meta-analysis, VTE is a fairly common complication after HSCT, emphasizing the importance of assimilating guidelines for both treatment and prophylaxis in this patient population.
Medical Graduate, Aga Khan University, Karachi, Pakistan.
Mohammad Faizan
MF
Zahid
Evidence-Based Practice Program, Mayo Clinic, Rochester, MN, USA.|Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, USA.
M Hassan
MH
Murad
Mayo Clinic Transplant Center, Blood and Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA.
Mark R
MR
Litzow
Mayo Clinic Transplant Center, Blood and Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA.
William J
WJ
Hogan
Mayo Clinic Transplant Center, Blood and Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA.
Mrinal S
MS
Patnaik
Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
Alok
A
Khorana
Hofstra-North Shore LIJ School of Medicine, Manhasset, NY, USA.
Alex C
AC
Spyropoulos
Mayo Clinic Transplant Center, Blood and Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA. Hashmi.Shahrukh@mayo.edu.
Shahrukh K
SK
Hashmi
D000208:Acute Disease; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
Bone marrow transplantation; Complication; Deep venous thrombosis; Hematopoietic stem cell transplantation; Pulmonary embolism; Venous thromboembolism