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Safety and efficacy of direct‐acting oral anticoagulants versus warfarin in kidney transplant recipients: a retrospective single‐center cohort study
Author(s) -
Bixby Alexandra L.,
Shaikh Suhail A,
Naik Abhijit S.,
Cotiguala Laura,
McMurry Katie,
SamaniegoPicota Milagros D.,
Marshall Vincent D.,
Park Jeong M.
Publication year - 2020
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13599
Subject(s) - medicine , warfarin , retrospective cohort study , single center , kidney transplant , kidney transplantation , cohort , cohort study , surgery , kidney , atrial fibrillation
Summary Despite the increased use, comparative safety and efficacy of direct‐acting oral anticoagulants (DOACs) against warfarin have not been well studied in kidney transplant recipients. In this single‐center retrospective study, we evaluated 197 adult kidney transplant recipients on DOAC or warfarin between January 1, 2011, and June 30, 2018. The primary outcome was incidence of major bleeding defined as a hemoglobin decrease ≥2 g/dl, blood transfusion ≥2 units, or symptomatic bleeding in a critical area or organ. Patients were initiated on anticoagulation therapy at a median of 6.5 years post‐transplant and followed for a median of 12.3 months. The rates of major bleeding were 7.2% per year with DOACs vs. 11.4% per year with warfarin (Mantel–Cox P  = 0.15). No difference was found in composite bleeding, clinically relevant nonmajor bleeding, or thromboembolic events between the groups. There was a lower incidence of major bleeding with apixaban compared to all other anticoagulants (6.7% vs. 19.0%, P  = 0.027). After controlling for potential confounders, DOAC use was not associated with an increased risk of major bleeding (HR 0.73, 95% CI 0.27–1.95). Further research is warranted to definitively determine whether DOACs are effective and safe alternatives to warfarin for anticoagulation in kidney transplant recipients.

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