*Purpose: Thromboembolic complications are common post-transplant leading to significant morbidity. We instituted early enoxaparin prophylaxis (ppx) in lung transplant recipients (LTR) due to an observed 36.8% incidence VTE (Incidence rate (IR) 5.74/1000pt days).

*Methods: Our ppx initiative commenced January 2015 with expectation of enoxaparin initiation within 6-8 hrs of ICU arrival and continuation for 4-6 weeks. We then prospectively evaluated the IR of VTE in LTR within 90 days of transplant. In 2016 the protocol was modified to extend the time to initiation of ppx to 72 hours of ICU arrival and better define inclusion and exclusion criteria, so as to enhance adherence.

*Results: Eighteen of 26 LTR met protocol inclusion criteria in 2015. Most were male with pulmonary fibrosis and a median LAS of 53.4. Six patients developed VTE, 50% of which were upper extremity (UE), line associated. Fifty two of 75 LTR were eligible for enoxaparin ppx in 2017. This cohort was statistically older with a lower median LAS score. Fifteen patients experienced 18 VTE, of which 86.6% were UE and 77.8% were line associated. Despite improved adherence in 2017, there was little change in VTE IR, 3.85/1000pt days compared to 3.90/1000pt days (figure 1).

*Conclusions: Our prospective study found that LTR remain at high risk for VTE despite aggressive ppx with 4-6 weeks of enoxaparin. Alternative interventions should be investigated to minimize VTE development in this vulnerable population.

« Back to 2019 American Transplant Congress