Abstract

Background: Liver transplant recipients often remain transiently hypercoagulable following transplantation. This is due to the inherent bleeding and clotting risks associated with the surgical procedure and to a disruption in coagulation homeostasis associated with cirrhotic disease. There is no guidance on the application of pharmacological venous thromboembolism (VTE) prophylaxis in this patient population. We sought to investigate the risk of bleeding and VTE in liver transplant recipients (n=38) who received pharmacological prophylaxis (n=11) versus (vs.) those who did not (n=27) during hospitalization. Results: The overall incidence of postoperative bleeding was 55.3%, and was lower in the group that received pharmacological prophylaxis (18.2% vs. 70.4%; p=0.002). The overall rate of major bleeding was 8%, with all 3 cases occurring in the group that did not receive pharmacological prophylaxis. We noted that patients who experienced bleeding in general had lower baseline platelets (p=0.01). Our study found no difference in the incidence of postoperative thromboembolic events, with an overall rate of 2.6% (n=1 case in the group that did not receive pharmacological prophylaxis). Readmission within 30 days due to bleeding or thromboembolic events also did not differ between the groups (0% vs. 4%; p=0.33 and 9% vs. 7%; p=0.97, respectively). Conclusion: Our results suggest that the incidence of post liver-transplant thromboembolic events are low, and that exposure to pharmacological thromboprophylaxis during admission of liver transplantation procedure is not associated with an increased risk of post-operative bleeding.