Assessing the Safety and Efficacy of Non-vitamin K Antagonist Oral Anticoagulants in Solid-Organ Transplant Recipients: A Comprehensive Analysis of a Transplant Center.

Abstract

Objectives: Atrial fibrillation is a common arrhythmia in solid-organ transplant recipients. Oral anticoagulant therapy is essential to prevent stroke and systemic embolism in atrial fibrillation. Warfarin is safe and effective, but non-vitamin K antagonist oral anticoa-gulants are an emerging alternative. We examined the safety/efficacy of non-vitamin K antagonist oral anticoagulants in solid-organ transplant recipients.

Materials and methods: We retrospectively evaluated electronic medical records of 52 solid-organ transplant recipients diagnosed with atrial fibrillation and collected information on demographics, electrocardiogram and laboratory data, anticoagulation treatment, and organ transplant. We compared patients with nonvalvular atrial fibrillation who received non-vitamin K antagonist oral anticoagulants versus warfarin and analyzed the incidence of systemic embolic events and major bleeding events. Scores for CHA2DS2-VASc (ie, congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) and Anticoagulation and Risk Factors in Atrial Fibrillation bleeding risk were obtained for risk assessment of thrombosis versus bleeding, respectively.

Results: Of the 43 patients, most were kidney transplant recipients (76.4%), followed by liver (13.9%) and heart (9.3%). Mean bleeding score was higher in the warfarin group, and mean thrombosis score was higher in the non-vitamin K antagonist oral anticoagulants group but not statistically significant. Incidence of major bleeding events was higher in the warfarin group but not statistically significant. Incidence of systemic embolic events was higher in the non-vitamin K antagonist oral anticoagulant group but not statistically significant.

Conclusions: This is the first study to characterize present use of non-vitamin K antagonist oral anticoagulants in solid-organ transplant recipients at a single center in Turkey. We observed that these agents are as effective as warfarin to prevent systemic embolic events and bleeding risks, with no significant difference between therapies. At our institution, we prefer non-vitamin K antagonist oral anticoagulants in patients with appropriate indications according to the benefit-risk profile.