Is Bridging Anticoagulation or Antiplatelet Reversal Necessary Prior to Kidney Transplantation?

J. C. Alonso-Escalante, R. P. Tindall, L. Machado, K. R. Tabar, N. Thai, T. Uemura

AHN Transplant Institute, Allegheny General Hospital, Pittsburgh, PA

Meeting: 2020 American Transplant Congress

Abstract number: A-053

Keywords: Anticoagulation, Blood transfusion, N/A, Post-operative complications

Session Information

Session Name: Poster Session A: Kidney: Cardiovascular and Metabolic Complications

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Pre-kidney transplant patients are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. The aim of this study is to evaluate whether kidney transplantation without bridging anticoagulation or antiplatelet reversal (clopidogrel +/- aspirin) is safe.

*Methods: Patients who have undergone kidney transplantation between January 2017 and July 2019 were studied and divided into three groups: pre-transplant anticoagulation with warfarin (n=21), pre-transplant antiplatelet therapy with clopidogrel +/- aspirin (n=15), and a control group (n=218). All patients underwent kidney transplantation without bridging anticoagulation or antiplatelet reversal. Pre-transplant variables analyzed were INR and platelet count. A comparison of post-transplant outcomes at 3 months included rates of hemodialysis, creatinine, rejection, and re-exploration for bleeding. The rate of prolonged length of stay (greater than 7 days), and perioperative blood transfusion was also evaluated. Statistical tests implemented in the analysis of data included chi-square and Kruskall Wallis.

*Results: Pre-transplant INR was significantly higher in the warfarin group. No difference among pre-transplant platelet count was found (table 1).

Table 1: Pre-transplant Variables at Time of Admission
	Control	Warfarin	Clopidogrel+/-ASA	p value
INR	1.1	2.2	1.2	<0.01
Platelet count (x10^3/mcL)	201	187	197	0.37

There were no statistically significant differences among the groups when comparing outcomes 3 months post-transplant, and the percentage of patients who required a perioperative blood transfusion was also not significantly different. The rate of re-exploration for bleeding and prolonged length of stay (LOS) was similar (table 2).

Table 2: Post-transplant Outcomes at 3 Months, Perioperative Blood Transfusion, Prolonged LOS
	Control	Warfarin	Clopidogrel+/-ASA	p value
Hemodialysis	30%	17%	7%	0.23
Creatinine (mg/dL)	1.5	1.7	1.7	0.13
Re-exploration for bleeding	1.9%	0%	7.1%	0.34
Rejection	6%	0%	0%	0.32
Perioperative Blood Transfusion	1%	5%	0%	0.27
Prolonged Length of Stay (>7 days)	32%	40%	66%	0.38

*Conclusions: Uninterrupted anticoagulation or antiplatelet therapy did not have a negative impact on post-transplant outcomes. Kidney transplantation can be performed without bridging anticoagulation or antiplatelet reversal as shown by our single-center retrospective study. This practice eliminates the risk of discontinuing therapeutic anticoagulation or antiplatelet therapy, and avoids any potential delay in kidney transplantation.

To cite this abstract in AMA style:

Alonso-Escalante JC, Tindall RP, Machado L, Tabar KR, Thai N, Uemura T. Is Bridging Anticoagulation or Antiplatelet Reversal Necessary Prior to Kidney Transplantation? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/is-bridging-anticoagulation-or-antiplatelet-reversal-necessary-prior-to-kidney-transplantation/. Accessed November 21, 2024.

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