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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.