Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study

Abstract

Background: The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.

Hypothesis: Pre-HT coagulopathy is associated with increased in-hospital mortality.

Methods: 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.

Results: The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P 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; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008).

Conclusions: 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.

Figure 1

Trends in prevalence of pre–heart transplant (HT) coagulopathy among heart transplant recipients. (A) Prevalence of pre‐HT coagulopathy was calculated as the number of patients with coagulopathy divided by the number of HT recipients each year; P trend <0.001. (B) Trends in pre‐HT coagulopathy presented as unadjusted and adjusted odds ratio (OR) for each year related to 2003 (reference year).

Figure 2

Kaplan‐Meier plots for in‐hospital mortality in the propensity‐matched cohort of heart transplant recipients with and without coagulopathy Abbreviations: CI, confidence interval; Coag., coagulopathy; HR, hazard ratio.

Figure 3

Hazard ratio and 95% confidence interval (CI) for in‐hospital mortality associated with pre–heart transplant coagulopathy in subgroups of matched patients.