Objective: There is a lack of high-level evidence identifying meaningful outcomes with direct oral anticoagulants (DOACs) in kidney transplant recipients. The primary objective of this study was to evaluate outcomes resulting from DOAC use in kidney transplant recipients.

Methods: In this single-center retrospective chart review, we evaluated adult kidney transplant recipients receiving DOAC therapy for cerebrovascular accident prophylaxis in non-valvular atrial fibrillation, or venous thromboembolism prophylaxis or treatment from January 1, 2011 to August 31, 2016. The primary outcome assessed the incidence of major bleeding events defined as a decrease in hemoglobin (Hgb) by at least 2 g/dl, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical area or organ during DOAC therapy.

Results: According to our predefined inclusion criteria, 62 patients were included in the study. Fourteen patients (22.6%) experienced a major bleed during DOAC therapy for a median follow-up of 8.7 months, leading to therapy discontinuation in 7 patients. There was no statistical difference in the incidence of major bleeding events between patients identified as receiving the appropriate DOAC dose versus those who did not receive appropriate dosing (19.4% vs. 3.2%, p = 1.00). Similarly, there was no difference in the incidence of major bleeding between patients with identified drug-drug interactions and those without drug-drug interactions (3.2% vs. 11.3%, p = 1.00).

Conclusions: DOAC therapy was not well tolerated in this cohort of kidney transplant recipients with respect to safety.

CITATION INFORMATION: Shaikh S., Samaniego M., Park J. Direct Oral Anticoagulation Use in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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