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Performance of a Prospective Anticoagulation Stratification Algorithm After Liver Transplantation
Jorge Sanchez-Garcia1, Fidel Lopez-Verdugo1,2, Spencer LeCorchick1
1Transplant and Hepatobiliary Surgery, Abdominal Transplant Services, Intermountain Medical Center, Murray, UT.
Transplantation Direct
|March 6, 2023
Summary
A quality improvement initiative for liver transplant (LT) patients with deep vein thrombosis (DVT) safely reduced therapeutic anticoagulation use and postoperative bleeding. This approach balances thrombosis and bleeding risks in high-risk LT recipients.
Area of Science:
- Hepatology and Transplant Surgery
- Vascular Medicine and Thrombosis
- Quality Improvement in Healthcare
Background:
- Liver transplantation (LT) patients face significant risks of venous thromboembolism (VTE) and bleeding post-surgery.
- Balancing anticoagulation for VTE prevention against bleeding risk is a critical clinical challenge in LT recipients.
- Limited evidence exists on optimal VTE management strategies in the immediate postoperative period after LT.
Purpose of the Study:
- To evaluate a quality improvement (QI) initiative using a VTE risk stratification algorithm for managing deep vein thromboses (DVTs) in liver transplant patients.
- To test the hypothesis that a subset of LT patients with postoperative DVTs can be managed without therapeutic anticoagulation.
- To assess the impact of the QI initiative on anticoagulation use, bleeding rates, and other early clinical outcomes.
Main Methods:
- A prospective QI initiative was implemented, comparing 182 LT patients (study group) to 87 historical LT controls.
- A standardized Doppler ultrasound-based VTE risk stratification algorithm guided the decision for therapeutic anticoagulation.
- Outcomes analyzed included immediate therapeutic anticoagulation rates, clinically significant bleeding, pulmonary embolism, and mortality within 30 days post-LT.
Main Results:
- The incidence of DVT was similar between the control (11.5%) and study groups (12.6%).
- The study group showed significantly lower rates of immediate therapeutic anticoagulation (21.7% vs. 70%) and postoperative bleeding (8.7% vs. 40%).
- No significant differences were observed in other early outcomes such as return to OR, readmission, pulmonary embolism, or death.
Conclusions:
- Implementing a risk-stratified VTE treatment algorithm for immediate post-liver transplant patients is safe and feasible.
- This QI initiative successfully reduced therapeutic anticoagulation use and postoperative bleeding without compromising early patient outcomes.
- A standardized, risk-stratified approach can optimize VTE management in liver transplant recipients.
