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Less bleeding associated with apixaban versus other direct acting oral anticoagulation in solid organ transplant

David M Salerno1, Megan E Thornberg1,2, Nicholas W Lange1

  • 1Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.

Clinical Transplantation
|June 24, 2021
PubMed
Abstract

Insights

Direct oral anticoagulants (DOACs) in solid organ transplant (SOT) recipients showed apixaban was linked to less bleeding than other DOACs. Proper DOAC dosing also reduced thrombosis risk in these patients.

Area of Science:

  • Transplantation Medicine
  • Pharmacology
  • Cardiovascular Research

Background:

  • Solid organ transplant (SOT) recipients often require anticoagulation.
  • Direct oral anticoagulants (DOACs) are increasingly used, but their outcomes in SOT populations require further study.
  • Bleeding and thrombosis are significant concerns in SOT patients on anticoagulation.

Purpose of the Study:

  • To evaluate bleeding and thrombosis outcomes associated with DOAC use in SOT recipients.
  • To compare outcomes between apixaban and other DOACs (rivaroxaban, dabigatran) in this cohort.
  • To identify factors influencing DOAC-related complications in SOT patients.

Main Methods:

  • Retrospective cohort study of 106 adult SOT recipients (kidney, heart, lung, liver) between 2009-2018.
  • Patients were divided into apixaban and non-apixaban (rivaroxaban or dabigatran) groups.
  • Primary endpoint: cumulative incidence of any bleeding. Secondary endpoints: major bleeding and thrombosis.

Main Results:

  • Apixaban use was associated with a significantly lower cumulative incidence of any bleeding at 90 days (4.9% vs 16.1%) and 180 days (11.4% vs 24.9%, P=.034).
  • Incidence of major bleeding and thrombosis did not differ significantly between the apixaban and non-apixaban groups.
  • Correct DOAC dosing, aligned with package inserts, correlated with a reduced risk of thrombosis.

Conclusions:

  • Apixaban-based anticoagulation demonstrated a lower cumulative incidence of bleeding compared to non-apixaban DOACs in SOT recipients.
  • DOACs can be used in SOT patients, with apixaban showing a favorable bleeding profile.
  • Adherence to recommended DOAC dosing is crucial for mitigating thrombosis risk.
Keywords:
apixabanbleedingdabigatranrivaroxabansolid organ tranplant

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