Use of Direct-acting Oral Anticoagulants in Solid Organ Transplantation: A Systematic Review.Bixby, A. L., et al.
Pharmacotherapy 2020 [record in progress].
The primary objective of this study was to compare the efficacy and safety of direct-acting oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in recipients of solid organ transplant (SOT).
A literature search was conducted on PubMed. Study selection was performed by two independent reviewers. Four investigators independently assessed the methodological quality of individual studies using the Newcastle-Ottawa Scale (NOS).
26 studies were included in the review.
Bleeding complications and thromboembolic events. The review also addressed how DOACs should be reversed and how doses should be modified for special populations.
The systematic review evaluated the safety and efficacy of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists in organ transplant recipients. PubMed was searched and nine full text articles and 17 congress abstracts were included by two independent reviewers. Two independent reviewers used the Newcastle-Ottawa scale to assess the methodological quality of studies. Results were summarised in a narrative review due to the heterogeneity of the studies. The evidence regarding the safety and efficacy of DOACs is limited. Four comparative, retrospective studies in liver, kidney and heart transplantation did not find differences in thrombotic events between DOACs and vitamin K antagonists but two studies found a lower incidence of bleeding events with DOACs. Variations in dosing regimens, drug-interactions and concomitant use of azole antifungals and antiplatelet agents were described in the literature, which may lead to differences in outcomes. The congress abstracts reported variable incidences of bleeding and thrombotic events after DOAC use.