Venous thromboembolism following hematopoietic stem cell transplantation-a systematic review and meta-analysis

Ann Hematol. 2016 Sep;95(9):1457-64. doi: 10.1007/s00277-016-2673-3. Epub 2016 Apr 22.

Abstract

Venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplantation (HSCT). Graft-versus-host disease (GVHD) is another complication of HSCT that may modify the risk of VTE. Our objective was to explore the incidence of VTE (deep venous thrombosis and pulmonary embolism) following HSCT and to evaluate its association with GVHD. A comprehensive search of Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus was conducted to search for both retrospective and prospective HSCT studies which had reported VTE. Random-effects meta-analysis was used to pool incidence rates. We included 17 studies reporting on allogeneic- and 10 on autologous-HSCT; enrolling 6693 patients; of which 5 were randomized. The overall incidence of VTE after HSCT was 5 % (4-7 %). Incidence in allogeneic-HSCT was 4 % (2-6 %) and in autologous-HSCT was 4 % (1-15 %). Eleven and nine studies reported data on acute and chronic GVHD, respectively. The incidence of VTE in chronic GVHD was 35 % (20-54 %), whereas in acute GVHD it was 47 % (32-62 %). Based on the results of this meta-analysis, VTE is a fairly common complication after HSCT, emphasizing the importance of assimilating guidelines for both treatment and prophylaxis in this patient population.

Keywords: Bone marrow transplantation; Complication; Deep venous thrombosis; Hematopoietic stem cell transplantation; Pulmonary embolism; Venous thromboembolism.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Chronic Disease
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Incidence
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / etiology
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Transplantation, Autologous
  • Transplantation, Homologous
  • Venous Thromboembolism / diagnosis*
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology
  • Venous Thrombosis / diagnosis*
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / etiology