Solid organ transplant patients are at risk of developing atrial fibrillation and venous thromboembolism. Direct oral anticoagulants are considered an attractive option for anticoagulation in patients due to their convenience; however, strong evidence of their use in transplantation is lacking. We conducted a search using Pubmed, Embase, and Scopus databases, in addition to International Society of Heart and Lung transplantation and American Transplant Congress abstracts (from 2012 through December 2017). Fourteen articles were reviewed that included case reports, retrospective case series, or chart review analyses of small cohorts. Based on this review, the findings can only generate hypotheses that should be further studied in a larger randomized cohort. This review can help clinicians gain insight into the use of direct oral anticoagulant in this special population. For now, clinicians should be cautious about their use in this special population.
JanuaryCTWannLSAlpertJS; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071–2104. doi:10.1161/CIR.0000000000000040
2.
LentineKLSchnitzlerMAAbbottKC. Incidence, predictors, and associated outcomes of atrial fibrillation after kidney transplantation. Clin J Am Soc Nephrol. 2006;1(2):288–296.
3.
NielsenTDBahnsonTDavisRDPalmerSM. Atrial fibrillation after pulmonary transplant. Chest. 2004;126(2):496–500.
4.
HamonDTaleskiJVaseghiMShivkumarKBoyleNG. Arrythmias in the heart transplant patient. Arrhythm Electrophysiol Rev. 2014;3(3):149–155. doi: 10.15420/aer.2014.3.3.149
5.
Saez-GimenezBBerasteguiCLoorK. Deep vein thrombosis and pulmonary embolism after solid organ transplantation: an unresolved problem. Transplant Rev (Orlando). 2015;29(2):85–92. doi:10.1016/j.trre.2014.12.005
6.
SaxenaNParajuliS. Spontaneous perinephric hematoma with newer oral anticoagulation in kidney transplant recipient. J Nephrol Renal Ther. 2016;2(1):1–2. doi:10.24966/NRT-7313/100002
7.
ShusterJELaRueSJVaderJM. Dabigatran may have more significant drug interactions with calcineurin inhibitors than oral anti-Xa inhibitors. [abstract]. J Heart Lung Transplant. 2016;35(4): S417. doi:10.1016/j.healun.2016.01.1204
8.
RimsansJRhotenMSylvesterKSinghSKConnorsJM. Idarucizumab for urgent reversal of dabigatran for heart transplant: a case report. Am J Hematol. 2017;92(3):E34–E35. doi:10.1002/ajh.24638
9.
IntagliataNMMaitlandHPellitierSCaldwellSH. Reversal of direct oral anticoagulants for liver transplantation in cirrhosis: a step forward. Liver Transpl. 2017;23(3):396–397. doi:10.1002/lt.24708
10.
TralhaoAAguiarCFerreiraJ. Dabigatran reversal with idarucizumab in a patient undergoing heart transplantation: first European report. Thromb J. 2017;15:23. doi:10.1186/s12959-017-0147-z
11.
LisikWJozwikACzerwinskiJGorskiLKosieradzkiM. Simultaneous pancreas-kidney transplantation can be safely done on dabigatran therapy. [abstract]. Am J Transplant. 2017;17(suppl 3):694.
12.
KimMGabardiSTownsendKRPageDSWoodcomeELGivertzMM. Post transplant thrombosis and atrial arrhythmia may be safely managed by direct oral anticoagulants in cardiac transplant patients. [abstract]. J Heart Lung Transplant. 2016;35(4):S123. doi:10.1016/j.healun.2016.01.338
13.
AmbrosiPKreitmannBCohenWHabibGMorangeP. Anticoagulation with a new oral anticoagulant in heart transplant recipients. Int J Cardiol. 2013;168(4):4452–4453. doi:10.1016/j.ijcard.2013.06.148
14.
VanhoveTSprietIAnnaertP. Effect of the direct oral anticoagulants rivaroxaban and apixaban on the disposition of calcineurin inhibitors in transplant recipients. Ther Drug Monit. 2017;39(1):77–82. doi:10.1097/FTD.0000000000000356
15.
WannhoffAWeissKHSchemmerPStremmelWGotthardtDN. Increased levels of rivaroxaban in patients after liver transplantation treated with cyclosporine A. Transplantation. 2014;98(2):e12–e13. doi:10.1097/TP0000000000000223
16.
RennerTAZalunardoMPWederWDR. Bilateral lung transplantation in a patient receiving rivaroxaban anticoagulation. J Cardiothorac Vasc Anesth. 2015;29(3):723–726. doi:10.1053/j.jvca.2014.06.003
17.
HazelcornJYauRSabaghaNMoaddabMMansonM. Risk of major bleeding in solid organ transplant recipients taking calcineurin inhibitors concomitantly with direct oral anticoagulants compared to warfarin. [abstract]. Am J Transplant. 2017;17(suppl 3):640.
18.
LichvarABMooreCAEnsorCRMcDyerJFTeutebergJJShulloMA. Evaluation of direct oral anticoagulation therapy in heart and lung transplant recipients. Prog Transplant. 2016;26(3):263–269. doi:10.1177/1526924816661951
19.
SalernoDMTsapepasDPapachristosA. Direct oral anticoagulant considerations in solid organ transplantation: a review. Clin Transplant. 2017;31(1). doi:10.1111/ctr.12873
20.
de JongeHde LoorHVerbekeKVanrenterghemYKuypersDR. In vivo CYP3A activity is significantly lower in cyclosporine-treated as compared with tacrolimus-treated renal allograft recipients. Clin Pharmacol Ther. 2011;90(3):414–422. doi:10.1038/clpt.2011.130
