Incidence and Risk Factors of Deep Vein Thrombosis After Liver Transplantation
Incidence and Risk Factors of Deep Vein Thrombosis After Liver Transplantation
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DOI：
10.1016/j.transproceed.2014.09.113
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发表时间：
2014-12-01
影响因子：
0.9
通讯作者：
Klein, A.
中科院分区：
文献类型：
--
作者：
Annamalai, A.;Kim, I.;Klein, A.
背景。每年有 0.1% 的人发生深静脉血栓 (DVT)，影响 15%-40% 未经预防的普通外科手术。由于存在出血和凝血障碍的风险，原位肝移植（LT）后不常使用血栓栓塞预防。肝硬化以及移植前后与凝血级联的关系尚不清楚。本研究的目的是确定 LT 后 DVT 的发生率及其危险因素。方法。我们回顾性回顾了 2005 年至 2012 年在我们中心进行的 LT。我们确定了多普勒检查显示 LT 后 DVT 的患者、血小板计数和 DVT 时的国际标准化比值 (INR)、相关症状、DVT 预防和围手术期危险因素。我们使用逻辑回归模型确定了 DVT 的发生率、每个术前危险因素的比值比、有和没有 DVT 患者之间血小板计数和 INR 的差异，以及每个因素在发生 DVT 中的加权风险。结果。 314 例患者中，DVT 发生率为 8.6%（27/314）。患有和不患有 DVT 的患者在年龄、性别、血小板计数、INR、感染、肝细胞癌、静脉旁路的使用和既往手术方面没有显着差异。迁移率有显着差异，分别为 67% 与 20% (P < .0001)，以及因子 VII 的使用情况，分别为 11% 与 2% (P < .05)。对于没有这些因素的患者，估计发生 DVT 的风险为 4%；因子 VII 的风险上升至 17%；由于行动不便，风险上升至 23%；两者的风险均为 62%。在我们的整个人群中，没有肺栓塞的病例。结论。即使采用机械 DVT 预防，LT 后发生 DVT 的风险也 >9%。 LT 后应考虑使用机械和化学预防。
Background. Deep venous thrombosis (DVT) occurs in 0.1% of persons per year, affecting 15%-40% of general surgical procedures without prophylaxis. Thromboembolic prophylaxis is not commonly used after orthotopic liver transplantation (LT) owing to the risks of bleeding and coagulopathy. Cirrhosis and the association with the coagulation cascade, before and after transplantation, are not well understood. The purpose of this study was to determine the incidence of DVT and its risk factors after LT.Methods. We retrospectively reviewed LTs performed at our center from 2005 to 2012. We identified patients with Doppler examinations showing DVT after LT, platelet count, and international normalized ratio (INR) at time of DVT, associated symptoms, DVT prophylaxis, and perioperative risk factors. We determined the incidence of DVT, the odds ratio of each preoperative risk factor, the difference in platelet count and INR between those with and without a DVT, and the weighted risk of each factor in the development of DVT with the use of logistic regression modeling.Results. Of 314 patients, the incidence of DVT was 8.6% (27/314). Between those with and without DVT there was no significant difference in age, sex, platelet count, INR, infection, hepatocellular cancer, use of venous bypass, and prior surgery. There was a significant difference in mobility, 67% vs 20% (P < .0001), and the use of factor VII, 11% vs 2% (P < .05). The estimated risk for of developing DVT for patients with neither of these factors was 4%; with factor VII the risk rose to 17%; with mobility difficulty the risk rose to 23%; and with both the risk was 62%. In our entire population, there were no cases of pulmonary embolism.Conclusions. The risk of developing a DVT after LT is >9% even with mechanical DVT prophylaxis. Consideration should be given to using both mechanical and chemical prophylaxis after LT.