Transplant Trial Watch

Efficacy and safety of chemical thromboprophylaxis in renal transplantation - A systematic review.

Kohli, R., et al.

Thrombosis Research 2020; 192: 88-95.


Aims
The aim of this study was to investigate the efficacy and safety of different chemical thromboprophylaxis (TP) agents in patients undergoing kidney transplantation

Interventions
Databases such as Pubmed, MEDLINE, World Health Organization International Clinical Trials Platform, Embase, CINAHL, Cochrane and ClinicalTrials.gov were searched from inception to December 16, 2019. Study selection and data extraction were carried out by two authors independently. Risk of bias was assessed using the Cochrane’s risk of bias assessment tool.

Participants
13 studies were included in the review.

Outcomes
The primary outcomes, assessed up to 3 months after transplantation, were effectiveness measures including symptomatic venous thromboembolism (VTE), asymptomatic VTE or renal graft thrombosis. Safety outcomes included major bleeding and mortality from VTE, major bleeding and all-cause. Secondary outcomes were measured up to 12 months following renal transplant. Clinically relevant non-major bleeding was also measured as a secondary outcome.

Follow-up
N/A

CET Conclusions
This is a good quality systematic review of chemical thromboprophylaxis in renal transplant recipients. The review was conducted within the framework set out in the Cochrane handbook and following the PRISMA guidelines; a protocol was registered with the PROSPERO system. A wide variety of sources were searched, and 2 reviewers independently assessed references for inclusion, and data was also extracted in duplicate. 13 Studies were included, with a total patient population of 1600 and these studies were formally assessed for risk of bias using appropriate tools. The review included 5 RCTs, 1 non-RCT and 7 cohort studies. Studies with a historic cohort for comparison were excluded. All included RCTs were assessed as being at high risk of bias, and all but 2 of the other studies included were assessed as being at serious risk of bias. Meta-analysis was not possible due to study heterogeneity, so a narrative analysis is presented. The authors have done a good job in searching through and trying to summarise this data. It is quite startling how poor the evidence base for thromboprohylaxis is in renal transplantation. The overall reporting of both symptomatic and asymptomatic VTE is very poor. Despite reviewing 13 studies, there is no conclusive evidence that thromboprophylaxis versus no treatment reduces VTE risk. Also, there is no evidence of any superiority of one thromboprophylaxis treatment over another. Compared to no thromboprophylaxis, there was some evidence that thromboprophylaxis may reduce the rate of renal allograft thrombosis, but this may be associated with increased risk of bleeding. The included studies were small and of low quality, but it is really quite amazing that we do not have evidence to guide best VTE prevention in renal transplantation

Quality notes
SR-QA not applicable

Trial registration
PROSPERO - CRD42018103137

Funding source
No funding received