Thromboprophylaxis of pancreas transplantation: a literature review

Abstract

Background: Pancreas thrombosis is a major complication after pancreas transplantation. Most centers use pharmacologic thromboprophylaxis with anticoagulants and antiplatelet drugs during and/or immediately after transplantation. Currently, there is no consensus on the best thromboprophylaxis in these patients.

Methods: A literature review of MEDLINE, SCOPUS and Google Scholar was done. Studies administered pharmacologic thromboprophylaxis after pancreas transplantation and reported thrombosis and/or bleeding complications were recruited.

Results: Aspirin, unfractionated or low-molecular weight heparin (LMWH) were the most utilized options. Dextran, antithrombin III, and warfarin have been occasionally used. The reported rates of thrombosis and bleeding ranged 4-43% and 0.3-58%, respectively.

Conclusion: Best regimen and duration of pharmacologic thromboprophylaxis in pancreas transplantation remained to be determined. Currently, low-dose aspirin is a common part of antithrombotic regimens that usually continues after discharge. Intraoperative heparin has been administered in some centers and appears to decrease the risk of thrombosis without increase risk of bleeding. Adding post-operative, prophylactic doses of intravenous or subcutaneous heparin starting while the patient is homeostatically stable, forms a part of current thromboprophylaxis regimen. LMWH has been sometimes substituted for heparin; although the dose adjustment according to renal function is a challenge. Warfarin should be reserved only for patients with hypercoagulability or for thrombosis treatment.