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Zakko J, Ganapathi AM, Whitson BA, et al. Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis. Clin Transplant. 2021;e14513doi: 10.1111/ctr.14513.
Zakko, J., Ganapathi, A. M., Whitson, B. A., Mokadam, N. A., Henn, M. C., Lampert, B., Kahwash, R., Franco, V., Haas, G., Emani, S., Hasan, A., & Vallakati, A. (2021). Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis. Clinical transplantation, e14513. https://doi.org/10.1111/ctr.14513
Zakko, Jason, et al. "Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis." Clinical transplantation vol. (2021): e14513. doi: https://doi.org/10.1111/ctr.14513
Zakko J, Ganapathi AM, Whitson BA, Mokadam NA, Henn MC, Lampert B, Kahwash R, Franco V, Haas G, Emani S, Hasan A, Vallakati A. Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis. Clin Transplant. 2021 Oct 16;e14513. doi: 10.1111/ctr.14513. Epub 2021 Oct 16. PMID: 34655500.
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Clin Transplant. 2021 Oct 16;e14513. doi: 10.1111/ctr.14513. Epub 2021 Oct 16.

Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis.

Clinical transplantation

Jason Zakko, Asvin M Ganapathi, Bryan A Whitson, Nahush A Mokadam, Matthew C Henn, Brent Lampert, Rami Kahwash, Veronica Franco, Garrie Haas, Sitaramesh Emani, Ayesha Hasan, Ajay Vallakati

Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
  2. Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
  3. Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

PMID: 34655500 DOI: 10.1111/ctr.14513

Abstract

There is limited evidence comparing direct oral anticoagulants (DOACs) and warfarin in solid organ transplant (SOT) recipients. We performed a pooled analysis to study the safety and efficacy of DOACs in this patient population. We searched PubMed, Embase, and Scopus databases using the search terms "heart transplant" or "lung transplant" or "liver transplant" or "kidney transplant" or "pancreas transplant" and "direct oral anticoagulant" for literature search. Random effects model with Mantel-Haenszel method was used to pool the outcomes. Pooled analysis included 489 patients, of which 259 patients received DOACs and 230 patients received warfarin. When compared to warfarin, the use of DOACs was associated with decreased risk of composite bleed (RR .49, 95% CI .32-.76, p = .002). There were no differences in rates of major bleeding (RR .55, 95% CI .20-1.49, p = .24) or venous thromboembolism (RR .65, 95% CI .25-1.70, p = .38) between the two groups. Evidence from pooled analysis suggests that DOACs are comparable to warfarin in terms of safety in SOT recipients. Further research is warranted to conclusively determine whether DOACs are safe alternatives to warfarin for anticoagulation in SOT recipients.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Keywords: coagulation and hemostasis; meta-analysis; pharmacokinetics/pharmacodynamics

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