Abstract
Purpose The use of direct oral anticoagulants (DOACs) has not been fully adopted by the solid organ transplant (SOT) community due to several transplant-specific factors including, fluctuating renal function, drug-drug interactions, routine biopsies, and the limited availability of reversal agents. In addition, there is limited data evaluating the safety and efficacy of using DOACs in SOT recipients. The purpose of this study is to assess the safety and efficacy of apixaban versus non-apixaban DOAC (NA-DOAC) therapy in cardiothoracic transplant recipients (CTRs). Methods A single center, retrospective chart review of heart, heart-kidney, and lung transplant recipients who received DOAC therapy between 1/1/2011-6/31/2018. Patients lost to follow-up or receiving a DOAC for less than one month were excluded. Results A total of 38 CTRs were included in the study with 26 (68.4%) receiving apixaban and 12 (31.6%) receiving NA-DOAC therapy (dabigatran n=2; rivaroxaban n=10). Baseline demographics were similar between the two cohorts (Table 1). There were numerically lower bleeding (12% vs. 25%, p = 0.35) and thromboembolic (15% vs. 33%, p=0.23) events in the apixaban vs. the NA-DOAC group. Potential risk factors for bleeding events in CTRs included age ≥72 (p=0.02), single-lung transplant recipients (p=0.006), and a HAS-BLED score ≥3 (p=0.03). There were no statistically significant risk factors for thromboembolic events, however, patients with events (n=8) were dosed below the recommended package insert dosing (50% vs. 27%, p=0.71). Conclusion Apixaban appears to be the more favorable DOAC in SOT patients due to decreased rates of bleeding and thromboembolic events. Patient-specific characteristics should be taken into consideration when initiating DOAC therapy in SOT patients.
Published Version
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