Use of Direct Anticoagulants in Kidney Transplant Recipients: Review of the Current Evidence and Emerging Perspectives.

IF 2.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Baris Afsar, Rengin Elsurer Afsar, Yasar Caliskan, Krista L Lentine
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引用次数: 0

Abstract

Thromboembolic events and atrial fibrillation are common among kidney transplant recipients (KTRs), and these conditions typically require anticoagulation. Traditionally, vitamin K antagonists were used for management, but the use of direct oral anticoagulants (DOACs) has increased in KTRs. In the general population, DOACs are recommended over warfarin, but the applicability of these recommendations to KTRs is unclear because of risk-benefit concerns. There is some hesitancy to use DOACs in KTRs because of their dependence on renal clearance for elimination, potential drug-drug interactions, and limited data. To date, studies of DOACs in KTRs have demonstrated that they are efficient in thromboembolic events, major bleeding is rare, and drug-drug interactions appear rare. However, no guidance yet exists about the use of DOACs, reversal of DOAC action, and the pre- and post-kidney transplant management of DOACs in KTRs, and the evidence base is scarce. Thus, decisions on DOAC use in KTRs are based on expert opinion and the resources and experiences of individual transplant centers. This review summarizes 10 published studies on the use of DOACs in 741 KTRs, evaluating the side effects, efficacy, drug-drug interactions, and perioperative management compared with those of 1320 KTRs using vitamin K antagonists. Although current data are limited, DOACs appear to be relatively safe and effective in KTRs, with some studies suggesting lower bleeding rates and better kidney function than with vitamin K antagonists. However, more research with larger patient groups is needed to draw definitive conclusions.

肾移植受者使用直接抗凝剂:当前证据和新观点回顾。
血栓栓塞事件和心房颤动在肾移植受者(KTR)中很常见,这些情况通常需要抗凝治疗。传统的治疗方法是使用维生素 K 拮抗剂,但直接口服抗凝剂 (DOAC) 在肾移植受者中的使用有所增加。在普通人群中,建议使用直接口服抗凝血剂(DOACs)而不是华法林,但由于风险效益方面的考虑,这些建议是否适用于 KTR 尚不明确。由于 DOACs 依赖于肾脏清除率的消除、潜在的药物相互作用以及有限的数据,人们对在 KTR 中使用 DOACs 有些犹豫不决。迄今为止,在 KTR 中使用 DOACs 的研究表明,它们对血栓栓塞事件有很好的疗效,很少发生大出血,药物间的相互作用似乎也很少发生。然而,关于 DOAC 的使用、DOAC 作用的逆转以及 DOAC 在 KTR 肾移植前后的管理,目前尚无指南,证据基础也很匮乏。因此,在 KTR 中使用 DOAC 的决定是基于专家意见以及各个移植中心的资源和经验。本综述总结了 10 项已发表的关于在 741 例 KTR 中使用 DOAC 的研究,评估了与 1320 例使用维生素 K 拮抗剂的 KTR 相比,DOAC 的副作用、疗效、药物相互作用和围手术期管理。虽然目前的数据有限,但 DOAC 在 KTR 中似乎相对安全有效,一些研究表明,与维生素 K 拮抗剂相比,DOAC 的出血率更低,肾功能更好。不过,要得出明确的结论,还需要对更大的患者群体进行更多的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.70
自引率
3.30%
发文量
38
审稿时长
>12 weeks
期刊介绍: Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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