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World J Hepatol. May 28, 2015; 7(9): 1238-1243
Published online May 28, 2015. doi: 10.4254/wjh.v7.i9.1238
Anticoagulation and antiplatelets as prophylaxis for hepatic artery thrombosis after liver transplantation
Abdullah A Algarni, Moustafa M Mourad, Simon R Bramhall
Abdullah A Algarni, Moustafa M Mourad, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom
Simon R Bramhall, General Surgery Department, Wye Valley NHS Trust, Hereford HR1 2BN, United Kingdom
Author contributions: Algarni AA designed the study; Algarni AA and Mourad MM collected, analysed, interpreted the data, and drafted the article; Bramhall SR designed the conception, critically revised the manuscript for important intellectual content, and made the final approval of the version to be published.
Conflict-of-interest: None of the authors has any potential conflicting financial interests relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Abdullah A Algarni, Liver Unit, Queen Elizabeth Hospital, Nuffield House 3rd Floor, Edgbaston, Birmingham B15 2TH, United Kingdom. abdullah.algarni@doctors.org.uk
Telephone: +44-742-7365931 Fax: +44-121-4141833
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: October 14, 2014
Revised: November 16, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 28, 2015
Processing time: 264 Days and 12.6 Hours
Abstract

Hepatic artery thrombosis (HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.

Keywords: Hepatic artery thrombosis; Haemostasis; Anticoagulation; Liver transplantation; Antiplatelets; Heparin

Core tip: Hepatic artery thrombosis (HAT) is the most serious vascular complication after liver transplantation. Changes in haemostasis associated with liver disease play a role in its development. Pharmacological prophylaxis may reduce its incidence and prevent graft loss. Few studies have shown a clear benefit of antiplatelets in reducing HAT occurrence, however, these studies have several limitations. The use of anticoagulants showed an improvement in the outcomes when used for high-risk patients. Their major concern is the tendency to increase bleeding complication. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance.