Efficacy and Safety of Direct Oral Anticoagulants in Solid Organ Transplant Recipients: A Meta-Analysis

Abstract

<h3>Purpose</h3> There is limited evidence comparing direct oral anticoagulants (DOACs) and warfarin in solid organ transplant recipients. We performed a pooled analysis to study the safety of DOACS in this patient population. <h3>Methods</h3> We searched PubMed, Embase, and Scopus databases from their inception to July 31, 2020 using the search terms "heart transplant" or "lung transplant" or "liver transplant" or kidney transplant" or "pancreas transplant" and "direct oral anticoagulant" for literature search. Random effects model with Mantel-Haenszel method was used to pool data of major bleeding, clinically relevant non-major bleeding, venous thromboembolism, and stroke. <h3>Results</h3> We identified five studies which compared DOACs with warfarin. Pooled analysis included 489 patients, of which 259 patients received DOACs and 500 patients received warfarin. When compared to warfarin, the use of direct oral anticoagulants was associated with decreased risk of composite bleed (RR 0.49, 95% CI 0.32 - 0.76, p=0.002)(Figure 1). There were no differences in rates of major bleeding (RR 0.55, 95% CI 0.20 - 1.49, p=0.24) or venous thromboembolism (RR 0.65, 95% CI 0.25 - 1.70, p=0.38) between the two groups. <h3>Conclusion</h3> Evidence from pooled analysis suggests that DOACs are comparable to warfarin in terms of safety in solid organ transplant recipients. Further research is warranted to conclusively determine whether DOACs are safe alternatives to warfarin for anticoagulation in solid organ transplant recipients.