Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

• Published in: Clinical transplantation 2015-07, Vol.29 (7), p.629-635
• Main Authors: Elboudwarej, Omeed, Patel, Jignesh K., Liou, Frank, Rafiei, Matthew, Osborne, Ashley, Chai, Wanxing, Kittleson, Michelle, Czer, Lawrence, Stern, Lily, Esmailian, Fardad, Kobashigawa, Jon A.
• Format: Article
• Language: English
• Subjects: Adult; deep vein thrombosis; Female; Follow-Up Studies; Graft Rejection - diagnostic imaging; Graft Rejection - etiology; Graft Rejection - mortality; Graft Survival; Heart Diseases - surgery; heart transplantation; Heart Transplantation - adverse effects; Humans; Lower Extremity - diagnostic imaging; Lower Extremity - pathology; Male; Middle Aged; Postoperative Complications; Prognosis; pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Retrospective Studies; Risk Factors; Survival Rate; transplants; Ultrasonography, Doppler, Duplex; Upper Extremity Deep Vein Thrombosis - diagnostic imaging; Upper Extremity Deep Vein Thrombosis - etiology; Upper Extremity Deep Vein Thrombosis - mortality; venous thromboembolism
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12566

Introduction Heart transplant patients have risk factors that place them at higher risk for acute venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), than the general population. We assessed for rate of VTE and incidence of PE‐related mortality among heart transplant patients. Materials and Methods A total of 1258 heart transplant patients were evaluated for the development of VTE. The diagnosis of DVT was made by Duplex ultrasonography, and PE was diagnosed by computerized tomography pulmonary angiography or ventilation–perfusion radionuclide scan. PE‐related mortality was assessed at one yr, three yr, and five yr post‐transplant. Results A total of 117 (9.3%) patients were diagnosed with DVT, including 65 of 117 (55.5%) with lower extremity DVT (LEDVT) and 52 of 117 (44.4%) with upper extremity DVT (UEDVT). A total of 24 (1.9%) patients experienced PE with seven (29.2%) resulting deaths. The rate of LEDVT and UEDVT was similar (55.5% vs. 44.4%); however, the incidence of PE was greater for those with LEDVT (23.1% vs. 7.7%; p = 0.04). Patients with PE had lower survival over the five‐yr follow‐up period compared to those with DVT only (67% vs. 81%; p = 0.51). Conclusion Heart transplant patients have a high incidence of VTE despite current best practice, indicating a need for a more aggressive approach to thromboprophylaxis.