Date: Monday, June 3, 2019
Session Name: Poster Session C: Kidney: Cardiovascular and Metabolic
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
- Direct Oral Anticoagulation Use in Kidney Transplant Recipients
- The Effect of Perioperative Antiplatelet/Anticoagulant Therapy on the Incidence of Early Postoperative Thromboembolic Complications and Bleeding in Kidney Transplantation – A Dual Center Retrospective Cohort Study of 2000 Kidney Transplant Recipients
*Purpose: Patients with atrial fibrillation (AF) have a higher risk of mortality and adverse cardiovascular events. Pre-operative AF has around 5-9% prevalence and roughly 5% of adult kidney transplant recipients (KTR) experience new onset AF (NOAF) post-operatively. Anticoagulation (AC) for AF is used to prevent stroke and systemic embolism after surgery. However, AC can increase the risk of bleeding. Evidence-based management guidelines do not currently exist for KTR with pre-existing AF (PAF) or NOAF.
*Methods: This is a single center retrospective analysis of adult KTR from May 1, 2016 to May 1, 2018 for PAF or NOAF and bleeding within 30-days post-transplant and the use of AC. HAS-BLED and CHA2DS2-VASc scores were calculated to estimate risk for bleeding and stroke, respectively. The endpoints were to compare the incidence of bleeding in KTR with and without AF and those with and without AC.
*Results: 212 KTR were included, 61% male with a mean age of 48 years (range 18-74 years), and 22 (10%) KTR had either PAF or NOAF. Among KTR with AF, 11 (50%) presented with bleeding, all of them on AC; 9 (82%) required an intervention and 2 (18%) stopped without an intervention. Among KTR without post-operative AF, 40 (21%) presented with bleeding; 30 (75%) required an intervention and 10 (25%) stopped bleeding without an intervention. Overall, 65% of KTR with AF who were anticoagulated had a post-operative bleed. The HAS-BLED score of the bleeding group had a median of 4 and the non-bleeding group had a median of 3. While there was no difference in HAS-BLED or CHA2DS2-VASc scores between KTR with and without AF (mean 4 vs. 3.6, p=0.11 and mean 2.6 vs. 2.1, p=0.08, respectively), AF KTR were significantly more likely to be placed on ACs after surgery (8% vs. 2%, p<0.0001). Moreover, while KTR with AF compared to those without AF were more likely to have a bleed (50% vs. 21%, p=0.004), after accounting for anticoagulant use, no difference in bleed risk was seen (p=0.31).
*Conclusions: In KTR with PAF or NOAF, AC is associated with a significant risk of bleeding, often resulting in additional interventions. Initiation of AC should be thoroughly evaluated in immediate KTR. The CHA2DS2-VASc and HAS-BLED scores are helpful tools for clinical decision-making, but are not ideal to evaluate KTR risks immediately post-transplant.
To cite this abstract in AMA style:Rodriguez PSerrano, Vijayakumar A, Strassle PD, Szempruch K, Desai CS, Vijay A, Toledo AH, Gerber DA. Postoperative Atrial Fibrillation in Kidney Transplant Recipients: A Retrospective Study Evaluating Risk of Anticoagulation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/postoperative-atrial-fibrillation-in-kidney-transplant-recipients-a-retrospective-study-evaluating-risk-of-anticoagulation/. Accessed February 27, 2021.
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