Published online Oct 28, 2019. doi: 10.5500/wjt.v9.i6.134
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 are increasingly being used in recent times for preventing stroke in individuals with atrial fibrillation and for the management of systemic embolic events and venous thromboembolism. With the increased risk of atrial fibrillation and thrombotic events observed in kidney transplant recipients, whether novel oral anticoagulants have clinical significance in this group of patients remains unclear.
Novel oral anticoagulants are being used as an oral anticoagulation agent for the prevention of embolic events in individuals with atrial fibrillation and for the treatment of venous thromboembolism. They also have the advantage of not requiring frequent monitoring and having a lower adverse effects profile. There are concerns regarding the clinical use of novel oral anticoagulants in renal transplant recipients because of its renal excretion and the likelihood of its interaction with immunosuppressive agents. Although, novel oral anticoagulants have successfully been used for anticoagulation in heart-lung transplant recipients, its use for this role in kidney transplant recipients is unknown.
We performed this retrospective study to assess the efficacy and safety of novel oral anticoagulants administration in patients after 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 novel oral anticoagulants (apixaban, rivaroxaban or dabigatran) in our renal transplantation program from December 2015 to December 2016. The outcomes of interest include the profile of the patients, thromboembolic and bleeding events, and kidney dysfunction.
The authors observed 3 (7.1%) bleeding events in the cohort. Also, no (0%) thromboembolic events were observed. In addition, no significant changes in pre- and post- novel oral anticoagulants tacrolimus level, creatinine level, and estimated glomerular filtration rates were observed.
Novel oral anticoagulants appear to be as effective in the renal transplantation population as in the general population. Also, we had a few bleeding events and no changes in renal function after the initiation of novel oral anticoagulants which suggests a good safety profile.
This study demonstrated that novel oral anticoagulants are safe and effective in renal transplant recipients. There is a need for further clinical studies to assess the mechanisms of bleeding in patients exposed to novel oral anticoagulants. Randomised controlled trials are needed to compare the effectiveness and safety of novel oral anticoagulants compared to other vitamin K antagonists (e.g., warfarin) in kidney transplant population.