2013 - ISBTS 2013 Symposium

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Mini-Oral Communications 2

26.362 - Pro-thrombotic disorders in a cohort of 25 patients undergoing transplantation- investigation and management implications.

Presenter: Charlotte , Pither, , United Kingdom
Authors: Charlotte Pither¹, Stephen Middleton¹, Rui Gao¹, Lisa Sharkey¹, Neville Jamieson², Andrew Butler²

Pro-thrombotic disorders in a cohort of 25 patients undergoing transplantation- investigation and management implications.

Charlotte Pither¹, Stephen Middleton¹, Rui Gao¹, Lisa Sharkey¹, Neville Jamieson², Andrew Butler²

¹Gastroenterology, Cambridge university hospitals NHS Foundation trust, Cambridge, United Kingdom; ²Transplantation Surgery, Cambridge university hospitals NHS Foundation Trust, Cambridge, United Kingdom

Methods:

We undertook a service analysis of 25 transplanted patients to identify the history of thrombotic episodes, the investigative process and management strategy.

Results:

We routinely perform thrombophilia screens in all patients assessed.

25 patients underwent transplantation between 2006-2012, 19/25 are alive. 5/25 patients were transplanted with history of porto-mesenteric thrombosis,6/25 had lost venous access due to thrombosis, and a further 6/25 had history of mesenteric ischaemia.

Pre-transplant: 16/25 patients were anti-coagulated. Thrombophilia screen identified: 3/16 patients JAK2 positive, 1/25 Anti-thrombin III deficiency, 1/25 a factor V leidin heterozygote. 1/25 had history of PE but negative screen.

Post-transplant: All patients anti-coagulated pre-transplant continued postoperatively, 1/16 infarcted their small bowel graft and 4/16 developed a further venous thrombosis despite anticoagulation.

2/9 patients with no history of thrombosis developed this post transplant: 1 pulmonary embolus more than a decade after transplant, another upper limb DVT associated with a line. Both were then anti-coagulated. 7/25 remain off anticoagulation although they all take anti-platelet prophylaxis.

Post-operative bleeding complications of anticoagulation occurred in 3, in 1 a sub-arachnoid haemorrhage- this patient is now on aspirin. The other 2 patients bled at ileal biopsy one requiring minimal treatment, the other due to platelet function disorder associated with JAK2 mutation/myeloproliferative disorder. Both remain on LMWH treatment.

Conclusion:Those with identifiable thrombophilic tendency, history of venous or arterial thrombosis are ‘high risk’ for post-operative recurrent thrombosis. Those without a history could be considered ‘low risk’. Our practice is to anti-coagulate all ‘high risk’ individuals pre and post-transplant and offer anti-platelet prophylaxis to low risk patients as the risk of anti-coagulation probably outweighs risk of thrombosis in them. Early input from haematologists is vital in the management of high risk patients particularly those who thrombose when anti-coagulated.

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