Pretransplant Coagulopathy and In‐hospital Outcomes Among Heart Transplant Recipients: A Propensity‐Matched Nationwide Inpatient Sample Study. Issue 5 (13th February 2015)

• Record Type: Journal Article
• Authors: Mujib, Marjan; Khanna, Neel; Mazumder, Nabila K.; Aronow, Wilbert S.; Kolte, Dhaval; Khera, Sahil; Palaniswamy, Chandrasekar; Jain, Diwakar; Lanier, Gregg M.; Sule, Sachin; Ahmed, Ali; Levy, Wayne C.; Prabhu, Sumanth D.; Cooper, Howard A.; Panza, Julio A.; Gass, Alan L.; Fonarow, Gregg C.
• Is Part Of: Clinical cardiology. Volume 38:Issue 5(2015:May)
• Page Start: 300
• Page End: 308
• Publication Date: 2015-02-13
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22391
• Languages: English
• ISSNs: 0160-9289

Abstract

<abstract abstract-type="main" id="clc22391-abs-0001"> <title>ABSTRACT</title> <sec id="clc22391-sec-0001" sec-type="section"> <title>Background</title> <p id="clc22391-para-0001">The prevalence and contemporary trends of pre–heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.</p> </sec> <sec id="clc22391-sec-0002" sec-type="section"> <title>Hypothesis</title> <p id="clc22391-para-0002">Pre‐HT coagulopathy is associated with increased in‐hospital mortality.</p> </sec> <sec id="clc22391-sec-0003" sec-type="section"> <title>Methods</title> <p id="clc22391-para-0003">Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre‐HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics.</p> </sec> <sec id="clc22391-sec-0004" sec-type="section"> <title>Results</title> <p id="clc22391-para-0004">The prevalence of pre‐HT coagulopathy increased from 17% in 2003 to 44% in 2010 (<italic>P</italic> for trend <0.001). In‐hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17‐2.80; <italic>P</italic> = 0.008). Coagulopathy was not significantly associated with post‐HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95‐1.52; <italic>P</italic> = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54–2.41; <italic>P</italic> < 0.001). Coagulopathy and no‐coagulopathy groups had no difference in median length of stay (22 days in each group, <italic>P</italic> = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; <italic>P</italic> = 0.008).</p> </sec> <sec id="clc22391-sec-0005" sec-type="section"> <title>Conclusions</title> <p id="clc22391-para-0005">In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post‐HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in‐hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.</p> </sec> </abstract>