In Patients with thrombophilia we administer (if necessary) oral anticoagulants like phenprocoumon.In case of transplantation we antagonize the effect of OAC with PPSB. After transplantation we apply heparin (2x12.500 IE subcutaneously) for the first days. If the situation is stable (especially no need for biopsy) we start OAC again.

KInd regards

Thomas Rath

This represents a heterogenous group of disorders so a single solution is not likely. Several authors suggest approaches based on whether the risk for thrombosis is low, intermediate, or high.

A team from Australia published its experience in Am J Cardiovasc Drugs. 2004;4(3):139-49. "Hypercoagulability in renal transplant recipients. Identifying patients at risk of renal allograft thrombosis and evaluating strategies for prevention."

They recommended the following (from the Abstract):

Interventions to reduce thrombotic risk including heparin, warfarin, and aspirin have been evaluated in both selected high-risk groups (heparin and warfarin) and unselected populations (heparin and aspirin). In unselected patients at low clinical risk, aspirin (75-150 mg/day) with or without a short period of unfractionated heparin (5000U twice a day for 5 days) appears to reduce the risk of renal allograft thrombosis significantly with a low risk of bleeding, especially when compared with low molecular weight heparins which risk accumulation in renal failure. In high-risk groups (identified thrombophilic risk factor, previous thrombosis, or SLE) longer period of heparin, with or without aspirin and maintenance with warfarin, should be considered. Re-transplantation following graft loss due to vascular thrombosis can be undertaken with a low risk of recurrence.

A more recent textbook refers to Morrissey et al report "Management of thrombophilia in renal transplant patients" in Am J Transplantation (Vo 2 No 9 October 2002 pp872-6) recommendations:

"Patients with diagnosis or suspected to have thrombophilia is suspected, the risk for thrombotic complications should be stratified as low, intermediate or high. In high risk are patients with inherited thrombotic disorder and history of at least two thrombotic episodes. For the high risk patients indefinite oral anticoagulation has been advocated. In intermediate risk are patients with a known inherited thrombotic disorder who are asymptomatic or have experienced a single thrombotic event. They should receive adequate prophylaxis in highrisk situations such as surgery for a minimum of 6 months. For patients with no suspicion of thrombophilia, no anticoagulation or a short term postoperative anticoagulation may be given."

Finally, one group from Kuwait correction of the hypercoagulable state after kidney transplantation. The article "Hypercoagulability, a serious problem in patients with ESRD on maintenance hemodialysis, and its correction after kidney transplantation" by Nampoory et al appeared in American Journal of Kidney Diseases Vol 42 No 4 October 2003 pp 797–805

The "general approach" as we handle this situation in our center is the same as described by Thomas Rath above.

Thank you for the rfereneces given by James.

Marcelo, thanks for the question, I'll use it when be back to SCMBH!!!