Abstract Number: PB1310
Meeting: ISTH 2020 Congress
Background: Graft thrombosis is one of the most frequent and potentially preventable causes of early allograft loss following pediatric renal transplant. There is conflicting evidence regarding the role of primary thromboprophylaxis.
Aims: To determine the effectiveness and safety of thromboprophylaxis in prevention of renal graft thrombosis among children (0-21 years) undergoing renal transplant.
Methods: A systematic literature review was conducted searching MEDLINE®, EMBASE and Cochrane Libraries from inception until September 2019. Primary outcomes were objectively proven graft thrombosis and major bleeding, defined as need for surgical exploration or PRBC transfusion. In the absence of randomized studies, non-experimental studies comparing patients with or without thromboprophylaxis were included in the analysis.
Results: Seven studies (5 retrospective, 2 prospective; Figure 1) describing 1012 patients (592 cases, 420 control) were included (Figure 2). Meta-analysis demonstrated thromboprophylaxis efficacy in prevention of graft thrombosis (odds ratio (OR) 0.35; 95% confidence interval (CI) 0.21 – 0.58). Subgroup analysis of patients treated only with heparinoids confirmed the protective effect of thromboprophylaxis (OR 0.51; 95% CI 0.30 – 0.58). There was a low degree of heterogeneity among the studies (I2=0). Major bleeding in relation to thromboprophylaxis was extracted from two studies and demonstrated an increased risk of bleeding (OR: 4.04; 95% CI 1.06 – 15.36). Subgroup analysis of major bleeding in heparinoid only cohorts showed similarly increased risk (OR 4.43; 95% CI 1.15 – 17.06).
Conclusions: Current evidence suggests that primary thromboprophylaxis is effective in preventing renal graft loss in pediatric recipients. This benefit is offset however by increased risk of bleeding (no fatal cases). Further research is required to determine optimal treatment regimen and duration in pediatric patients with diverse allograft needs.
To cite this abstract in AMA style:Al-Huniti A, Malcolmson C, Toeh CW, Langlois V, Lorenzo A, Williams S, Brandao L. Effectiveness and Safety of Primary Thromboprophylaxis in Pediatric Renal Transplant: a Systematic Review of the Literature and Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/effectiveness-and-safety-of-primary-thromboprophylaxis-in-pediatric-renal-transplant-a-systematic-review-of-the-literature-and-meta-analysis/. Accessed November 30, 2023.
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