A Review of Direct-acting Oral Anticoagulants and Their Use in Solid Organ Transplantation

Area of Science:

• Pharmacology and Therapeutics
• Transplantation Medicine
• Clinical Review

Background:

• Direct-acting oral anticoagulants (DOACs) offer advantages over traditional anticoagulants like warfarin.
• DOACs have seen widespread adoption due to proven efficacy and improved safety profiles in the general population.
• There is a significant lack of comprehensive data on DOACs in solid organ transplant (SOT) recipients.

Approach:

• Systematic literature review of existing studies on DOACs in transplant patients.
• Analysis of safety and efficacy data from preoperative, perioperative, and postoperative periods.
• Evaluation of current considerations for anticoagulation management in transplant recipients.

Key Points:

• DOACs present a potential alternative for anticoagulation in transplant candidates and recipients.
• Limited evidence exists regarding the specific risks and benefits of DOACs in this vulnerable patient group.
• Further research is crucial to establish optimal anticoagulation strategies using DOACs in transplantation.

Conclusions:

• The current evidence base for DOAC use in organ transplant recipients is insufficient.
• Careful consideration and further investigation are needed to guide the safe and effective application of DOACs in transplant medicine.
• This review highlights the need for evidence-based guidelines for DOAC management in patients undergoing or awaiting organ transplantation.