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Updated: Oct 21, 2025
Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
Can direct oral anticoagulants be used in kidney transplant recipients?
Kathrine Parker1,2, Janette Chu3, Muir Morton1
1Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK.
Background:
Kidney transplant recipients(KTRs) are at an increased risk of venous thromboembolism (VTE) and atrial fibrillation(AF). Direct oral anticoagulants (DOACs) have shown important advantages over vitamin K antagonists; however, in KTRs, concerns regarding interactions and use in severe kidney disease may limit their use. This evaluation describes a large UK kidney transplant center's experience of DOACs in KTRs with CrCl > 15 mL/min.
Methods:
Electronic records were reviewed for all adult KTRs at Manchester University Foundation Trust Hospitals taking DOACs between January 2018 and October 2020 with VTE or AF. The primary outcome was trough and peak DOAC levels within the expected reference ranges and secondary outcomes included bleeding and thrombotic events.
Results:
In 31 KTRs taking DOACS, eight patients had a CrCl < 30 mL/min. Overall, 94% (62/66) of DOAC levels were within the recommended ranges. There were no thrombotic events and four bleeding events (two major and two clinically relevant non-major bleeds). The overall bleeding rate was 6.9 per 100 patient-years at risk.
Conclusions:
There was no evidence of a significant interaction of apixaban or rivaroxaban with CNIs based on expected DOAC and CNI levels. Their use was found to be safe and effective with no VTE events and bleeding episodes similar to published trial data.
Insights
Direct oral anticoagulants (DOACs) are safe and effective for kidney transplant recipients (KTRs) with atrial fibrillation or venous thromboembolism. Drug levels remained within recommended ranges, with low rates of bleeding and no thrombotic events observed.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Kidney transplant recipients (KTRs) face elevated risks of venous thromboembolism (VTE) and atrial fibrillation (AF).
- Direct oral anticoagulants (DOACs) offer advantages over vitamin K antagonists, but potential interactions and use in severe kidney disease warrant investigation in KTRs.
Purpose of the Study:
- To evaluate the safety and efficacy of DOACs in KTRs.
- To assess DOAC drug levels and clinical outcomes, including bleeding and thrombotic events, in a UK kidney transplant center.
Main Methods:
- Retrospective review of electronic records for adult KTRs taking DOACs between January 2018 and October 2020.
- Primary outcome: DOAC trough and peak levels within reference ranges. Secondary outcomes: bleeding and thrombotic events.
Main Results:
- 31 KTRs were included; 8 had a creatinine clearance (CrCl) < 30 mL/min.
- 94% of DOAC levels were within recommended ranges.
- No thrombotic events occurred; 4 bleeding events (2 major, 2 clinically relevant non-major) were recorded, with an overall bleeding rate of 6.9 per 100 patient-years.
Conclusions:
- DOACs (apixaban, rivaroxaban) demonstrated no significant interaction with calcineurin inhibitors (CNIs).
- DOAC use was safe and effective in KTRs, with outcomes comparable to published trial data.
- No VTE events were observed, and bleeding rates were consistent with expectations.
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