Prevalence of Thrombophilia and Thrombogenic Factors among 122 Heart Transplant Recipients

Abstract

Purpose Thrombophilia (TF) and thrombogenic risk factors may affect the postoperative and long-term outcome after heart transplantation (HTX). We evaluated the prevalence of TF and thrombogenic risk factors among HTX candidates. The ultimate goal will be to analyze patient outcome in relation to preoperative findings of hypercoagulable factors upon the completion of the follow-up of ten years by 12/2012. Methods and Materials Patients with severe heart failure were prospectively screened in association with HTX routines during 2003-2011. TF screening comprised of Factor V Leiden (FVL) and prothrombin G20210A mutations, antithrombin (AT), lupus anticoagulant, cardiolipin and β2-glycoprotein I IgG antibodies. Thrombogenic risk factors included FVIII:C, thrombin time, fibrinogen (FG), and D-dimer at HTX screening and again Results In all, 136 HTX were performed and 122 recipients (60% males) had full TF screening. 55% of the patients had cardiomyopathy, 24% ischemic heart failure, 9% myocarditis or inflammatory heart disease, and 7% congenital heart disease. 80% used warfarin anticoagulation. Mean age was 49 (range 18-67) years. During the follow-up (range 11-109 months) 20 HTX recipients (16%) died. TF was established in 10%; 5 FVL (4%), 1 prothrombin mutation (0,8%) and 6 positive cardiolipin antibodies (5%). As main preoperative findings mean FG and D-dimer levels were elevated, 4.6±1.3 g/L (normal 1.7-4.0) and 1.0 ± 2.1 mg/L (normal 190%, normal 52-148) in 40 (33%) patients. AT was low ( Conclusions The prevalence of TF among HTX recipients was similar to normal population. Acquired thrombogenic factors were upregulated, despite the anticoagulant treatment, compatible with coagulation activity in severe heart failure. In one third of the patients FVIII was clearly elevated reflecting endothelial activation and acute phase reaction. Antithrombin, however, maintained its activity in the vast majority of the patients.