Use of Direct ‐acting Oral Anticoagulants in Solid Organ Transplantation: A Systematic Review

AbstractThe 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 numer ous 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‐sp ecific 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 dev iations 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.

Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - November 6, 2020 Category: Drugs & Pharmacology Authors: Alexandra L. Bixby, Alicia B. Lichvar, David Salerno, Jeong M. Park Tags: TI ON TRANSPLANTATION Source Type: research