Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
- The Effect of Perioperative Antiplatelet/Anticoagulant Therapy on the Incidence of Early Postoperative Thromboembolic Complications and Bleeding in Kidney Transplantation – A Dual Center Retrospective Cohort Study of 2000 Kidney Transplant Recipients
- Complications of Dual Antiplatelet Therapy Among Recipients of Kidney Transplants.
*Purpose: Pre-kidney transplant patients are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. The aim of this study is to evaluate whether kidney transplantation without bridging anticoagulation or antiplatelet reversal (clopidogrel +/- aspirin) is safe.
*Methods: Patients who have undergone kidney transplantation between January 2017 and July 2019 were studied and divided into three groups: pre-transplant anticoagulation with warfarin (n=21), pre-transplant antiplatelet therapy with clopidogrel +/- aspirin (n=15), and a control group (n=218). All patients underwent kidney transplantation without bridging anticoagulation or antiplatelet reversal. Pre-transplant variables analyzed were INR and platelet count. A comparison of post-transplant outcomes at 3 months included rates of hemodialysis, creatinine, rejection, and re-exploration for bleeding. The rate of prolonged length of stay (greater than 7 days), and perioperative blood transfusion was also evaluated. Statistical tests implemented in the analysis of data included chi-square and Kruskall Wallis.
*Results: Pre-transplant INR was significantly higher in the warfarin group. No difference among pre-transplant platelet count was found (table 1).
|Platelet count (x10^3/mcL)||201||187||197||0.37|
There were no statistically significant differences among the groups when comparing outcomes 3 months post-transplant, and the percentage of patients who required a perioperative blood transfusion was also not significantly different. The rate of re-exploration for bleeding and prolonged length of stay (LOS) was similar (table 2).
|Re-exploration for bleeding||1.9%||0%||7.1%||0.34|
|Perioperative Blood Transfusion||1%||5%||0%||0.27|
|Prolonged Length of Stay (>7 days)||32%||40%||66%||0.38|
*Conclusions: Uninterrupted anticoagulation or antiplatelet therapy did not have a negative impact on post-transplant outcomes. Kidney transplantation can be performed without bridging anticoagulation or antiplatelet reversal as shown by our single-center retrospective study. This practice eliminates the risk of discontinuing therapeutic anticoagulation or antiplatelet therapy, and avoids any potential delay in kidney transplantation.
To cite this abstract in AMA style:Alonso-Escalante JC, Tindall RP, Machado L, Tabar KR, Thai N, Uemura T. Is Bridging Anticoagulation or Antiplatelet Reversal Necessary Prior to Kidney Transplantation? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/is-bridging-anticoagulation-or-antiplatelet-reversal-necessary-prior-to-kidney-transplantation/. Accessed October 23, 2020.
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