Thromboprophylaxis of pancreas transplantation: a literature review

Pancreas thrombosis is a significant 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.

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.

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 from 4-43% and 0.3-58%, respectively.

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