Utilization of Direct Acting Oral Anticoagulation in Solid Organ Transplant Patients: A National Survey of Institutional Practices
1University of Illinois at Chicago, Chicago, IL, 2NewYork-Presbyterian Hospital, New York, NY, 3University of Colorado Hospital, Aurora, CO, 4Massachusetts General Hospital, Boston, MA, 5University of Michigan, Ann Arbor, MI
Meeting: 2020 American Transplant Congress
Abstract number: C-234
Keywords: Anticoagulation, Post-operative complications
Session Information
Session Name: Poster Session C: Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The safety and efficacy of direct acting oral anticoagulants (DOACs) and reversal strategies are not well established in the solid organ transplant population. This was a survey of transplant pharmacists to assess DOAC use and urgent reversal practices among adult transplant programs in the United States.
*Methods: A 27-question survey was distributed to members of transplant pharmacy organization listservs between 5/28/19 and 6/30/19. The survey focused on the practice patterns of DOAC therapy in the pre-, peri-, and post-transplant phases. The survey was completed using a Qualtrics® platform (Qualtrics, Provo, UT). Surveys were distributed via the American Society of Transplantation Transplant Pharmacy Community of Practice listserv, the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network listserv, and the International Society of Heart and Lung Transplantation Scientific Council on Pharmacy and Pharmacology listserv.
*Results: A total of 115 responses were received from kidney (43.5%), heart (20.0%), lung (18.3%), liver (13.9%), and pancreas (4.4%) transplant programs. DOAC use was prohibited in transplant candidates at 42.6% of programs. If permitted, apixaban (57.8%) was most preferred. At transplant surgery, reversal of DOAC was performed “as needed” (20.9%) or was not routine (18.3%). DOAC use post-transplant was more permissive (94.3%). Most responders follow FDA recommended dosing in the setting of drug-drug interactions (51.1%). Major factors influencing DOAC prescribing decisions included renal function, drug-drug interactions, and insurance. Table 1 details additional survey findings.
*Conclusions: High clinical practice variability exists regarding DOAC utilization and urgent reversal strategies in pre-, peri- and post-transplant stages. While more research is needed to refine the clinical landscape, many institutions are using DOAC therapy under the perception that they pose a similar risk of bleeding compared to a non-transplant population.
To cite this abstract in AMA style:
Pierce D, Lichvar A, Salerno D, Klem P, Waldman G, Park JM. Utilization of Direct Acting Oral Anticoagulation in Solid Organ Transplant Patients: A National Survey of Institutional Practices [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-of-direct-acting-oral-anticoagulation-in-solid-organ-transplant-patients-a-national-survey-of-institutional-practices/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress