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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Evaluation of Heparin Anticoagulation Protocols in Post-Renal Transplant Recipients (EHAP-PoRT Study)
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Evaluation of Heparin Anticoagulation Protocols in Post-Renal Transplant Recipients (EHAP-PoRT Study)

机译：肾移植接受者肝素抗凝血方案评价（EHAP-港口研究）

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Background: Disturbances in hemostasis are common among renal transplant recipients. Because of the risk of thromboembolism and graft loss after transplant, a prophylactic heparin protocol was implemented at St Pauls Hospital in Vancouver, British Columbia, in 2011. Therapeutic heparin is sometimes prescribed perioperatively for patients with preexisting prothrombotic conditions. There is currently limited literature on the safety and efficacy of heparin use in the early postoperative period. Objectives: The primary objectives were to document, for patients who underwent renal transplant, the incidence of major bleeding and of thrombosis in those receiving therapeutic heparin, prophylactic heparin, and no heparin anticoagulation in the early postoperative period and to compare these rates for the latter 2 groups. The secondary objectives included a comparison of the risk factors associated with major bleeding and thrombosis. Methods: Adult patients who received a renal transplant at St Paul's Hospital between January 2008 and July 2013 were included in this retrospective cohort study. Electronic health records and databases were used to divide patients into the 3 heparin-use cohorts, to identify cases of major bleeding and thrombosis, and to characterize patients and events. The Fisher exact test was used for the primary outcome analysis, and descriptive statistics were used for all other outcomes. Results: A total of 547 patients were included in the analysis. Major bleeding was observed in 6 (46%) of the 13 patients who received therapeutic heparin; no cases of thrombosis occurred in these patients. Major bleeding occurred in 8 (3.0%) of the 266 patients who received prophylactic heparin and 9 (3.4%) of the 268 who received no heparin (p > 0.99). Thrombosis occurred in 1 (0.4%) and 3 (1.1%) of these patients, respectively (p = 0.62). Major bleeding occurred more frequently among patients with a low-target heparin protocol, but 61% of values for partial thromboplastin time were above target. A larger proportion of deceased-donor transplant recipients who had major bleeding were taking antiplatelet agents, relative to living-donor transplant recipients. Conclusion: Therapeutic use of heparin increased the risk of bleeding among renal transplant recipients, but there were no cases of thrombosis. Prophylactic use of heparin did not increase the risk of bleeding and prevented proportionately more cases of thrombosis relative to no anticoagulation; this result supports the continued use of prophylaxis.
机译：背景：肾移植受者的止血紊乱是常见的。由于移植后血栓栓塞和接枝损失的风险，2011年在不列颠哥伦比亚省温哥华的圣保罗院实施了预防性肝素议定书。治疗性肝素有时针对预先存在的普发形成病症的患者进行过围手术。目前有有限的文献是术后早期使用肝素使用的安全性和疗效。目标：主要目标是记录，对术后治疗肝素，预防肝素，预防性肝素和肝素抗凝的那些患者进行肾移植的患者以及血栓形成的血栓形成，并在术后期间进行比较后者的这些利率2组。次要目标包括与主要出血和血栓形成相关的风险因素的比较。方法：2008年1月至2013年7月在圣保罗医院接受肾移植的成年患者纳入了这项回顾性队列研究。电子健康记录和数据库用于将患者分成3肝素使用的队列，以识别重大出血和血栓形成的病例，并表征患者和事件。 Fisher精确测试用于主要结果分析，并用于所有其他结果的描述性统计数据。结果：分析中共有547名患者。在接受治疗性肝素的13例患者中观察到主要出血;这些患者没有发生血栓形成病例。主要出血发生在8例（3.0％）的266名患者中，接受预防性肝素和9（3.4％）的268名没有肝素（p> 0.99）。血栓形成分别发生在1（0.4％）和3（1.1％）的这些患者中（P = 0.62）。患有低靶肝素方案的患者的主要出血更频繁地发生，但部分血栓形成时间的61％的值高于靶标。相对于居民主移植受者，患有重大出血的死亡捐助者移植受者的更大比例的死亡者进行了抗血小板药物。结论：肝素治疗用途增加了肾移植受者出血的风险，但没有血栓形成的病例。预防肝素的使用并未增加出血的风险，并相比预防更多的血栓形成情况;该结果支持继续使用预防。

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