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Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and

Chujun He1, Chunchun Yao2

  • 1Chujun He, Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang Province 325000, China.

Pakistan Journal of Medical Sciences
|July 2, 2024
PubMed
Abstract

Insights

Direct oral anticoagulants (DOAC) may be safer than Vitamin K antagonists (VKA) for transplant patients, showing reduced bleeding risk. Further research is needed to confirm efficacy and safety in solid organ transplant recipients.

Area of Science:

  • Transplant Medicine
  • Pharmacology
  • Clinical Research

Background:

  • Solid organ transplant recipients often require anticoagulation for various indications.
  • Direct oral anticoagulants (DOAC) and Vitamin K antagonists (VKA) are commonly used anticoagulants.
  • Comparative safety and efficacy data for DOAC versus VKA in this specific population are limited.

Purpose of the Study:

  • To systematically review and meta-analyze the available evidence comparing the safety and efficacy of DOAC versus VKA in patients with solid organ transplants.
  • To assess the risk of bleeding events, venous thromboembolism (VTE), and ischemic stroke in transplant recipients treated with DOAC compared to VKA.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, Embase, and Web of Science databases.
  • Studies published from inception up to November 25, 2023, comparing DOAC with VKA in solid organ transplant recipients were included.
  • Meta-analysis was performed on data from nine included studies involving kidney, heart, and liver transplant recipients.

Main Results:

  • DOAC use was associated with a significantly reduced risk of composite bleeding compared to VKA (RR: 0.45; 95% CI: 0.30, 0.68).
  • No significant difference was observed in the risk of major bleeding between DOAC and VKA groups (RR: 0.76; 95% CI: 0.40, 1.42).
  • The risk of VTE (RR: 0.90; 95% CI: 0.72, 1.13) and ischemic stroke (RR: 0.87; 95% CI: 0.39, 1.94) did not significantly differ between the two anticoagulant groups.

Conclusions:

  • Current limited evidence suggests that DOAC are safe and effective alternatives to VKA in patients with solid organ transplants.
  • DOAC may offer a potential benefit by reducing the overall risk of bleeding in this patient population.
  • High-quality evidence from randomized controlled trials is warranted to definitively establish the comparative effectiveness and safety of DOAC versus VKA in solid organ transplant recipients.
Keywords:
AnticoagulationApixabanBleedingStrokWarfarin

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