Volume 41, Issue 1 pp. 28-43
Review Of Therapeutics

Use of direct-acting oral anticoagulants in solid organ transplantation: A systematic review

Alexandra L. Bixby

Alexandra L. Bixby

Department of Pharmacy Services, University of Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

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Alicia B. Lichvar

Alicia B. Lichvar

Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA

Department of Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA

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David Salerno

David Salerno

Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA

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Jeong M. Park

Corresponding Author

Jeong M. Park

Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA

Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA

Correspondence

Jeong M. Park, College of Pharmacy, University of Michigan, 1111 Catherine St., VVH 302, Ann Arbor, MI 48109-2435, USA.

Email: [email protected]

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First published: 06 November 2020
Citations: 19

Abstract

The use of direct-acting oral anticoagulants (DOACs) has increased secondary to the mounting evidence for comparable efficacy and potentially superior safety to vitamin K antagonists (VKAs) in the general population. However, insufficient data regarding DOAC use in solid organ transplant (SOT) recipients and numerous pharmacokinetic and pharmacodynamic considerations limit their use in this highly selected patient population. A systematic review of recent clinical evidence on the safety and efficacy of DOACs compared to VKAs in SOT recipients was conducted. Additional considerations including transplant-specific strategies for DOAC reversal and common pharmacokinetic/pharmacodynamic concerns were also reviewed. Although current evidence is limited to single-center retrospective analyses, DOACs, especially apixaban, appear to be a safe and effective alternative to VKAs for SOT recipients with stable graft function and without drug-drug interactions. Reliable data on DOAC reversal at the time of transplant surgery are lacking, and clinicians should consider idarucizumab, andexanet alfa, and other non-specific reversal agents on an individual patient basis. There is no evidence supporting deviations from the Food and Drug Administration labeling recommendations for DOAC dosing in the setting of drug-drug interactions, obesity, and renal function, especially in patients on hemodialysis.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.