Upper extremity deep venous thrombosis (UEDVT) is common in post-heart transplant (OHT) patients, likely due to their multiple intravascular catheters and post-surgical state. The clinical sequelae of UEDVT and value of anticoagulation have not been delineated in this population. OHT patients represent a unique sample in whom anticoagulation is particularly cumbersome and potentially dangerous.

We performed a retrospective cohort study examining the incidence of UEDVT within six months after OHT. We recorded recurrence of UEDVT, incidence of pulmonary embolism (PE), and presence of concomitant lower extremity DVT within one year. We also noted the presence and duration of anticoagulation. Additionally, we captured bleeding complications for all patients with UEDVT. Pearson's chi square test and Fisher's exact tests were used to calculate significance for categorical variables. Mann-Whitney U tests were used to calculate significance for continuous variables. The significance level was set at 0.05.

We reviewed 124 consecutive OHTs performed at our hospital from 2004-2014. Of these, 50 cases (40.3%) experienced UEDVT. PE occurred in one patient (2%) and UEDVT recurred in 11 (22%). 20 patients were anticoagulated (40%) and 19 (38%) suffered bleeding complications. There was no significant difference in survival, UEDVT recurrence, PE, or number of bleeding complications at one year between those on anticoagulation versus those who were not. In those with UEDVT, there were 1,357 total days spent on anticoagulation and 9 bleeding events for an average of one bleeding event per 150.7 days. In comparison, there were 16,893 total days without anticoagulation, and 16 bleeding events during this time, yielding an average of one bleed every 1,055.8 days. Additionally, patients who suffered bleeding complications had a 15.8% lower one year survival rate (p = 0.049).

UEDVT was common in our post-OHT population. We found no significant difference in recurrent UEDVT or PE between those who were anticoagulated and those who were not. However, we discovered an increased daily bleeding risk of approximately seven-fold while on anticoagulation. Also, survival one year from OHT was significantly lower in those who experienced a bleed. The decision of whether to anticoagulate OHT patients with UEDVT should be made with careful attention to bleeding risk.

CITATION INFORMATION: Panakos A, Kramer D, McCarey M, Mather P. Management and Outcomes of Upper Extremity Deep Venous Thrombosis in Heart Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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