Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The use of direct oral anticoagulants (DOACs) has not been fully adopted by the solid organ transplant (SOT) community due to factors including, fluctuating renal function, drug-drug interactions, routine biopsies, limited availability of reversal agents, and the paucity of literature in this population. The purpose of this study is to assess the safety and efficacy of DOAC therapy in SOT recipients.
*Methods: A single center, retrospective study of all SOT 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. The primary outcome was the composite of safety (bleeds) and efficacy (thromboembolic events) between apixaban versus non-apixaban DOAC (NA-DOAC) treated patients.
*Results: A total of 109 SOT recipients were included in this study with 80 (73%) receiving apixaban and 29 (27%) receiving NA-DOAC therapy (dabigatran n=8; rivaroxaban n=21). Baseline demographics were similar between the two cohorts (Table 1). There was no difference in the primary composite endpoint between NA-DOAC and the apixaban group (24% vs. 22%, p = 1.0). There were numerically higher bleed rates in the apixaban group (15% vs. 10%, p = 0.75) however 93% of these bleeds were minor. The incidence of thromboembolic events in the apixaban group was nearly half of the NA-DOAC group (7% vs. 13%, p = 0.45). Of note, more patients in the apixaban group were dosed inappropriately than in the NA-DOAC group (57% vs. 34%, p =0.05) with 93% of patients being under-dosed. When analyzing the entire cohort, potential risk factors for bleeding events include age ≥72 (p=0.04) and lung transplant recipients (p = 0.05). Heart transplant recipients experienced significantly higher thromboembolic events (p=0.01) with 40% due to interrupted therapy.
*Conclusions: To date, this is the largest retrospective study analyzing the role of DOAC therapy in SOT recipients. Patient-specific characteristics should be taken into consideration when initiating DOAC therapy in SOT patients.
To cite this abstract in AMA style:Pasley T, Logan A, Brueckner A, Bowman L, Silverman A, Rumore A. Direct Oral Anticoagulants: An Evaluation of the Safety and Efficacy in Solid Organ Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/direct-oral-anticoagulants-an-evaluation-of-the-safety-and-efficacy-in-solid-organ-transplant-recipients/. Accessed April 2, 2020.
« Back to 2019 American Transplant Congress