PB1042 - Impact of preoperative anticoagulation on perioperative bleeding in patients undergoing cardiopulmonary bypass for heart and lung transplantation

Background: Perioperative bleeding occurs in up to 15% of patients undergoing cardiothoracic surgery and can be associated with poor outcomes. Anticoagulation is commonly indicated in patients with end-stage heart and lung disease requiring organ transplantation. Limited data exist surrounding pre-transplant anticoagulation and its effects on perioperative bleeding in patients undergoing cardiopulmonary bypass (CPB).

Aims: To investigate the association between anticoagulation prior to CPB for heart or lung transplant and perioperative bleeding.

Methods: This single-center, retrospective cohort analysis, approved by the Institutional Review Board, included patients who received heart or lung transplants between July 2019 and July 2022. Baseline demographics, preoperative anticoagulation and reversal agents, surgical characteristics, intraoperative blood product usage, and clinical outcomes were retrieved from patient charts. The cohorts assessed were patients who received and did not receive anticoagulation within 72 hours prior to transplant. The major endpoint was intraoperative major bleeding defined by ISTH criteria for surgical patients. Other endpoints included ISTH major bleeding within 72-hours postoperatively, 7-day postoperative thrombotic events (venous thromboembolism, myocardial infarction, ischemic stroke), and 30-day all-cause mortality. The end of surgery was the index time. Data were analyzed using Pearson’s chi-square, Fisher’s exact, or Mann-Whitney U.

Results: Of the 178 patients undergoing CPB for transplantation, 81 (46%) received preoperative anticoagulation. There was no difference in ISTH intraoperative major bleeding between groups (OR 1.25, 95% CI, 0.69 – 2.27, p=0.46). More patients on preoperative anticoagulation received postoperative FFP (15 vs 7, p=0.02). No additional differences in blood product administration were noted between groups (Table). There were no differences in 72-hour postoperative major bleeding (p=0.64), 7-day postoperative thrombotic events (p=0.37), and 30-day all-cause mortality (p=0.14) (Figure).

Conclusion(s): No differences were observed in the incidence of intraoperative or postoperative major bleeding, postoperative thrombotic events, or 30-day mortality between patients who received and didn’t receive anticoagulation prior to heart or lung transplant.