*Purpose: A number of hypercoagulable states have been identified through laboratory testing that place patients at greater risk for thrombosis; however, the appropriate management of these patients after renal transplant remains poorly defined. This study compares a strategy of prolonged venous thromboembolism (VTE) prophylaxis with an anticoagulant to aspirin therapy alone.

*Methods: This was a single-center, retrospective review of isolated adult renal transplant recipients between January 2014 and January 2018, with at least one of the following hypercoagulable states: Factor V Leiden mutation, prothrombin G20210A mutation, antithrombin deficiency, protein C/S deficiency, mutation in the tissue plasminogen activator inhibitor-1, elevated factor VIII, or antiphospholipid syndrome. Patients were excluded if they had a history of malignancy, hepatic cirrhosis, were on anticoagulation prior to transplant, or had an index hospital stay longer than 10 days. The choice of post-operative VTE prophylaxis was at the discretion of the transplant surgeon. Patients were evaluated in two groups based upon whether they received aspirin alone (ASA) or aspirin in combination with an anticoagulant (ASA+AC) following hospital discharge. The co-primary endpoints for this review were clinically significant bleeding or VTE confirmed by imaging within 30 days of transplant.

*Results: A total of 77 patients (ASA=52, ASA+AC=25) were included in the study. The mean age was 52.2 ± 11.3 years, and hypertension was the most frequent etiology of renal disease. There were no differences between the treatment groups at baseline with regard prior VTE (9.6% vs. 16.0%; p=0.40) or body mass index (27.2 vs. 26.8; p=0.75), but the ASA+AC arm was younger (47.7 vs 54.4; p=0.02) and more likely to have received a living donor graft (88.0% vs 59.6%; p=0.01). Extended VTE prophylaxis consisted of enoxaparin 1 mg/kg for 2-4 weeks post-transplant for the majority of patients, but one patient each received fondaparinux and warfarin. At the conclusion of the study, there were no significant differences between the ASA and ASA+AC treatment arms with regard to the incidence of clinically significant bleeding (15.4% vs. 4%; p=0.15) or imaging confirmed VTE (3.8% vs. 0%; p=0.35), although both outcomes numerically favored the prolonged prophylaxis arm. No bleeding events in either group required surgical or radiologic intervention, and all thrombotic events were classified as non-life threatening.

*Conclusions: Our retrospective analysis suggests that the overall incidence of VTE within 30 days of renal transplantation in patients with quantifiable hypercoagulable states is low with ASA prophylaxis alone (3.8%). In patients with multiple hypercoagulable risk factors, a prolonged prophylaxis regimen of enoxaparin 1 mg/kg for 2-4 weeks may be considered, and was not associated with more bleeding in our cohort.

« Back to 2019 American Transplant Congress