Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients: Risks and Prevention

Abstract

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are surgical complications estimated to occur in 5% to 10% of patients. There are limited data regarding DVT/PE in the early postoperative period in liver transplant patients. The aim of this study is to determine risk factors that influence the incidence of DVT/PE and the effectiveness of prophylaxis.

Methods: We reviewed the records of 999 patients who underwent initial liver transplant between January 2000 and June 2012 at Henry Ford Hospital. In 2011, a standardized prophylactic regimen using subcutaneous (SQ) heparin was initiated. All patients that developed either upper/lower extremity DVT or PE within the first 30 days of transplant formed the cohort of this study.

Results: On multivariate analysis, only peripherally inserted central catheter (PICC) placement and SQ heparin were associated with DVT/PE. In patients receiving heparin, 3 (1.0%) had DVT/PE versus 25 (3.5%) who did not receive heparin (P = 0.03). Sixteen (6.9%) patients that had a PICC developed DVT/PE compared with 12 (1.6%) patients without a PICC (P < 0.001). In the heparin group, DVT/PE with PICC was reduced to 3 (3.0%) versus 13 (9.9%) in those with a PICC and did not receive heparin (P = 0.03). Mean time from transplant to DVT/PE diagnosis was 12.3 days. Length of hospitalization was significantly longer in patients who developed DVT/PE (18.5 vs 10.0 days, P < 0.001).

Conclusions: In this study, we demonstrated that PICC placement significantly increases the likelihood of DVT/PE in liver transplant recipients. Prophylactic SQ heparin effectively reduced DVT/PE events in this patient population.

FIGURE 1

PICC line placement and risk of VTE. The use of a PICC line in OLT patients during hospitalization was identified to determine whether it had an impact on posttransplant VTE. PICC line placement was found to significantly increase the incidences of VTE in OLT patients. Data were analyzed by χ² test of independence. ***P < 0.0001.

FIGURE 2

Effectiveness of SQ heparin on reducing the risk of VTE. SQ heparin was given prophylactically to OLT patients to prevent posttransplant VTE. SQ heparin significantly decreased the incidences of VTE in OLT patients, in both groups with or without PICC line placement. Data were analyzed by χ² test of independence. *P < 0.05.