Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Oct 28, 2019; 9(6): 134-144
Published online Oct 28, 2019. doi: 10.5500/wjt.v9.i6.134
Efficacy and safety of non-vitamin K antagonist oral anticoagulants post-kidney transplantation
Muhammad A Bukhari, Abdulrahman Al-Theaby, Mohammed Tawhari, Ali Al-Shaggag, Ryan Pyrke, Azim Gangji, Darin Treleaven, Christine Ribic
Muhammad A Bukhari, Department of Medicine, Taif University, Taif 26311, Saudi Arabia
Abdulrahman Al-Theaby, Mohammed Tawhari, Department of Transplantation, King Abdulaziz Medical City, Riyadh 11159, Saudi Arabia
Ali Al-Shaggag, Department of Nephrology and Transplantation King Fahad Specialist Hospital, Dammam 15215, Saudi Arabia
Ryan Pyrke, Azim Gangji, Darin Treleaven, Christine Ribic, Department of Nephrology, McMaster University, Hamilton, ON L8N 4A6, Canada
Author contributions: Al-Theaby A, Tawhari M, Al-Shaggag A, Pyrke R, Gangji A, Treleaven D, Bukhari MA, and Ribic C contributed to acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Bukhari MA contributed to conception and design of the study, and critical revision.
Institutional review board statement: The study protocol was reviewed and approved by the Hamilton Integrated Research Ethics Board (
Informed consent statement: This was a retrospective study of anonymized/deidentified medical charts and health records. In consideration of the study design, the Hamilton Integrated Research Ethics Board waived request for informed consent from patients.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Muhammad A Bukhari, FRCP, MD, MSc, Assistant Professor, Department of Medicine, Taif University, Taif 26311, Saudi Arabia.
Telephone: +996-553502550
Received: July 18, 2019
Peer-review started: July 21, 2019
First decision: August 2, 2019
Revised: September 17, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: October 28, 2019

Novel oral anticoagulants (NOACs) were developed as alternatives to vitamin K antagonists, primarily warfarin, as they do not require routine monitoring and have limited drug-drug and drug-food interactions. However, the efficacy and safety of these agents in kidney transplantation are not well studied.


To assess the profile and safety of NOACs for patients who had kidney transplantation, and to provide recommendations and guidelines on therapeutic strategies in these patients.


This was a retrospective study carried out among adult patients who were actively on the following NOACs (apixaban, rivaroxaban or dabigatran) in our renal transplantation program from December 2015 to December 2016. The patients were identified primarily through electronic medical record system (patient data linkage). Data on the clinical and laboratory profile of the patients were retrieved and analyzed with SPSS 22.0.


Complete data on 42 renal transplant patients were retrieved: 59.5% males, 90.5% were whites and 66.7% were older than 60 years old. The mean duration since renal transplantation of the patients was 8.8 ± 7.4 years. The most common risk factors for the development of end-stage renal disease in the subjects were hypertension (19.0%), polycystic kidney disease (19.0%), followed by diabetic nephropathy (16.7%) and chronic glomerulonephritis (16.7%). The main indications for NOACs use in the cohort were atrial fibrillation in 25 patients (59.5%) and venous thromboembolism in 10 patients (23.8%). Overall, 29 patients (69%) were treated with apixaban, 10 patients (23.8%) with rivaroxaban and 3 patients (7.14%) with dabigatran. No (0%) thromboembolic events were observed during the one-year period, but 3 (7.1%) bleeding events occurred in the cohort consisting of 1 patient treated with rivaroxaban 15 mg daily and 2 patients who received apixaban 2.5 mg twice daily. There were no significant changes in serum tacrolimus level three days after the initiation of NOACs among patients treated with tacrolimus (pre- and post-NOACs tacrolimus levels were 7.2516 and 7.8867 ng/mL, P = 0.55, respectively). Also, after one-year of treatment with NOACs there were no significant changes in the pre- and post-NOACs serum creatinine level (P = 0.772) and estimated glomerular filtration rates (P = 0.232).


No thromboembolic events or significant changes in renal profile were observed in our cohort of kidney transplant recipients who were treated with NOACs for at least a year. However, a few bleeding events were observed. This calls for further well-planned randomized controlled trials to assess the efficacy and safety of NOACs among renal transplant recipients.

Keywords: Novel oral anticoagulants, Adult patients, Kidney transplantation, Renal outcomes, Efficacy

Core tip: No consensus is available in the literature about whether novel oral anticoagulants are effective and safe for renal transplant recipients. This is one of the first attempts to investigate the profile, safety and effectiveness of novel oral anticoagulants for adult renal transplant recipients. We investigated the role of novel oral anticoagulants in terms of its effect on thromboembolism, bleeding, creatinine clearance and immunosuppressive agents.