Kidney Transplant Recipient With DVT
A 55-year-old man had a living-donor kidney transplant for nephroangiosclerosis. The surgery was uneventful, but 15 days after the surgery, he developed a deep venous thrombosis in the femoral-popliteal segment of his left leg. The transplant was in the right iliac fossa. The risk factors are tacrolimus and absence of physical activity. How long should anticoagulant therapy be given?

Adel Al-Ansary, MD

Fifteen days after transplantation, I would treat the patient with anticoagulation. If standard intravenous heparin is to be given prior to starting warfarin, it would be important not to overheparinize the patient and cause hemorrhage from the wound; if low-molecular-weight heparin (LMWH) is to be given prior to starting the warfarin, the dose should again not be excessively high, to eliminate bleeding complications. We have seen bleeding in two thirds of our patients when LMWH 1 mg/kg twice daily was used with baby aspirin. Therefore, I would not give more than 0.5 mg/kg twice daily before converting to warfarin and I would probably treat for 6 months with warfarin.