Safety and efficacy of direct‐acting oral anticoagulants versus warfarin in kidney transplant recipients: a retrospective single‐center cohort study

Bixby, Alexandra L; Shaikh, Suhail; Naik, Abhijit S.; Cotiguala, Laura; McMurry, Katie; Samaniego‐Picota, Milagros; Marshall, Vincent D.; Park, Jeong Mi

doi:10.1111/tri.13599

Cited by 16 publications

(38 citation statements)

References 29 publications

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“…Prior to 2020, reports on the DOAC use among SOT recipients were limited to single‐center, retrospective case series without control arms (Table 1). 17–42 Among the abstracts from ATC and ISHLT, the incidences of major bleeding (0%–23%) and composite bleeding (0%–37%) ranged widely, and the incidence of thrombotic events was also variable (0%–21%).…”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

“…In early 2020, four single‐center retrospective cohort studies were published comparing DOACs to VKAs in SOT recipients 17–20 . Table 2 summarizes the study population, anticoagulants, and efficacy and safety outcomes of the studies 17–20 . The NOS quality assessments for each study were listed in Table 17–20 …”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

“…Table 2 summarizes the study population, anticoagulants, and efficacy and safety outcomes of the studies 17–20 . The NOS quality assessments for each study were listed in Table 17–20 …”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

“…Researchers 17 compared kidney transplant recipients taking DOACs ( n = 99) to those taking warfarin ( n = 98) between 2011 and 2018. Patients who required anticoagulation for mechanical valve, had inadequate follow‐up, multiorgan transplant, gastrointestinal bleeding in the last 6 months, anticoagulation for <30 days (unless stopped early due to bleed), or indication for anticoagulation other than VTE and NVAF were excluded.…”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

“…Similarly, there was a lower incidence of major bleeding when apixaban was compared with warfarin (6.7% vs. 21.4%, p = 0.014). The authors concluded that further research is warranted to definitively determine whether DOACs are safe and effective alternatives to warfarin for kidney transplant recipients 17 …”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

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Use of direct‐acting oral anticoagulants in solid organ transplantation: A systematic review

et al. 2020

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The use of direct‐acting oral anticoagulants (DOACs) has increased secondary to the mounting evidence for comparable efficacy and potentially superior safety to vitamin K antagonists (VKAs) in the general population. However, insufficient data regarding DOAC use in solid organ transplant (SOT) recipients and numerous pharmacokinetic and pharmacodynamic considerations limit their use in this highly selected patient population. A systematic review of recent clinical evidence on the safety and efficacy of DOACs compared to VKAs in SOT recipients was conducted. Additional considerations including transplant‐specific strategies for DOAC reversal and common pharmacokinetic/pharmacodynamic concerns were also reviewed. Although current evidence is limited to single‐center retrospective analyses, DOACs, especially apixaban, appear to be a safe and effective alternative to VKAs for SOT recipients with stable graft function and without drug‐drug interactions. Reliable data on DOAC reversal at the time of transplant surgery are lacking, and clinicians should consider idarucizumab, andexanet alfa, and other non‐specific reversal agents on an individual patient basis. There is no evidence supporting deviations from the Food and Drug Administration labeling recommendations for DOAC dosing in the setting of drug‐drug interactions, obesity, and renal function, especially in patients on hemodialysis.

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Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

“…Table 2 summarizes the study population, anticoagulants, and efficacy and safety outcomes of the studies 17–20 . The NOS quality assessments for each study were listed in Table 17–20 …”

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

Section: Safety and Efficacy Of Doac In Solid Organ Transplantmentioning

confidence: 99%

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