Angus H Pegler, Katharine Hegerty, Ryan P Gately, Carmel M Hawley, David W Johnson, Yeoungjee Cho, Dev K Jegatheesan, Andrew B McCann, Michelle E Harfield, Nicole M Isbel
{"title":"短期和长期阿司匹林预防肾移植后血栓栓塞并发症的发生率:一项回顾性单中心研究。","authors":"Angus H Pegler, Katharine Hegerty, Ryan P Gately, Carmel M Hawley, David W Johnson, Yeoungjee Cho, Dev K Jegatheesan, Andrew B McCann, Michelle E Harfield, Nicole M Isbel","doi":"10.12659/AOT.939143","DOIUrl":null,"url":null,"abstract":"<p><p>BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.</p>","PeriodicalId":7935,"journal":{"name":"Annals of Transplantation","volume":"28 ","pages":"e939143"},"PeriodicalIF":1.1000,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/f9/anntransplant-28-e939143.PMC10276531.pdf","citationCount":"0","resultStr":"{\"title\":\"Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin Prophylaxis: A Retrospective Single-Center Study.\",\"authors\":\"Angus H Pegler, Katharine Hegerty, Ryan P Gately, Carmel M Hawley, David W Johnson, Yeoungjee Cho, Dev K Jegatheesan, Andrew B McCann, Michelle E Harfield, Nicole M Isbel\",\"doi\":\"10.12659/AOT.939143\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.</p>\",\"PeriodicalId\":7935,\"journal\":{\"name\":\"Annals of Transplantation\",\"volume\":\"28 \",\"pages\":\"e939143\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2023-06-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/f9/anntransplant-28-e939143.PMC10276531.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.12659/AOT.939143\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12659/AOT.939143","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:阿司匹林预防与肾移植后移植物相关血栓的减少有关。然而，停用阿司匹林会增加静脉血栓栓塞并发症的风险，包括肺血栓栓塞和深静脉血栓形成。这项来自澳大利亚布里斯班的单中心、回顾性、介入前和介入后研究，旨在比较1208名成年肾移植受者术后服用阿司匹林5天或>6周的血栓并发症发生率。材料和方法我们招募了1208名肾移植受者，他们在术后5天(n=571)或>6周(n=637)服用100mg阿司匹林。通过多变量logistic回归分析，主要结局为移植后前6周静脉血栓栓塞(VTE)。次要结局是肾静脉/动脉血栓形成、1个月血清肌酐、排斥反应、心肌梗死、中风、输血、第5天和第28天透析和死亡率。结果16例(1.3%)患者发生静脉血栓栓塞(5天n=8, 1.4%;>6周n=8, 1.3%;P = 0.8)。延长阿司匹林服用时间与静脉血栓栓塞降低没有独立相关性(OR 0.91, 95% CI 0.32-2.57;P = 0.9)。移植物血栓罕见(n=3, 0.25%)。阿司匹林持续时间与心血管事件、输血、移植物血栓形成、移植物功能障碍、排斥反应或死亡率无关。静脉血栓栓塞与年龄较大独立相关(OR 1.09, 95% CI 1.04-1.16;P=0.002)，吸烟(OR 3.59, 95% CI 1.20-13.2;P=0.032)，较年轻的供体年龄(OR 0.96, 95% CI 0.93-1.00;P=0.036)，胸腺球蛋白的使用(OR 10.5, 95% CI 3.09-32.1;P≥0.001)。结论:在肾移植后的前6周，长期服用阿司匹林并没有显著降低静脉血栓栓塞的发生率。抗人胸腺细胞免疫球蛋白与静脉血栓栓塞之间存在关联，这需要进一步的评估。
Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin Prophylaxis: A Retrospective Single-Center Study.
BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.
期刊介绍：
Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation.
Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time to first decision is around 3-4 weeks. Time to publication of accepted manuscripts continues to be shortened, with the Editorial team committed to a goal of 3 months from acceptance to publication.
Expert reseachers and clinicians from around the world contribute original Articles, Review Papers, Case Reports and Special Reports in every pertinent specialty, providing a lot of arguments for discussion of exciting developments and controversies in the field.
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