*Purpose: Background: Utilization of direct-acting oral anticoagulants has become a preferred method for chronic anticoagulation in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). Apixaban use in renal dysfunction is supported by limited evidence as these patients were excluded from clinical trials in AF. Further, solid organ transplant recipients are often excluded from clinical trials resulting in a lack of data. The purpose of this study is to compare the efficacy and safety outcomes of apixaban use in both renal and non-renal transplant recipients.

*Methods: The current study is a single-center, retrospective analysis of apixaban use in solid organ transplant recipients compared to those without renal transplant or end stage renal disease (ESRD). Patients were matched 1:1 based on glomerular filtration rate (GFR) in accordance with the chronic kidney disease (CKD) staging system. The primary objective of this study is to compare the composite outcome of major bleeding and stroke in renal transplant patients and those without transplant or ESRD at one year. Secondary objectives include apixaban dose appropriateness at initiation, one month, three months, six months, and one year.

*Results: Patient demographics were comparable between the matched treatment and control groups (Table 1). When stratified according to CKD classification (1-4), mean GFR in non-transplant vs. transplant groups were similar. The primary indication for kidney transplant was hypertension and diabetes accounting for 28% (n=6) of transplants, followed by focal segmental glomerulosclerosis and glomerulonephritis. For the primary safety outcome, there were no bleeding episodes in either group at one year. One patient in the transplant group experienced a stroke while on apixaban. No patients in either group were prescribed medications that had significant drug interactions with apixaban. Apixaban dose was appropriate during the majority of the time intervals studied; however, under-dosing was seen at initiation and one month after initiation with 32% vs.18% and 25% vs.11% dosed inappropriately in the transplant vs. control groups, respectively.

*Conclusions: Preliminary results suggest similar safety and efficacy of apixaban in both renal and non-renal transplant patients. Bleeding and stroke rates in both groups were comparable, however, under-dosing apixaban at initiation and one month after initiation may be associated with a higher incidence of VTE in renal transplant patients.

« Back to 2019 American Transplant Congress