title: Direct oral anticoagulant considerations in solid organ transplantation: A review.
abstract: For more than 60 years, warfarin was the only oral anticoagulation agent available for use in the United States. In many recent clinical trials, several direct oral anticoagulants (DOACs) demonstrated similar efficacy with an equal or superior safety profile, with some other notable benefits. The DOACs have lower inter- and intrapatient variability, much shorter half-lives, and less known drug-drug and drug-food interactions as compared to warfarin. Despite these demonstrated benefits, the use of DOACs has not gained uniform acceptance because of lack of supportive data in special patient populations, including recipients of solid organ transplants maintained on immunosuppression. This review describes the properties of several novel DOACs including their pharmacology and mechanisms of action as they relate to use among solid organ transplant recipients. We have particularly focused on (i) dosing in patients with impaired renal and hepatic function; (ii) considerations for drug-drug interactions with immunosuppressive medications; and (iii) management of the anticoagulated patients at the time of unplanned surgery. The risks and benefits of the use of DOACs in solid organ transplant recipients should be carefully evaluated prior to the introduction of these agents in this highly distinct patient population.
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Salerno
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.|Department of Surgery, Division of Abdominal Transplantation, Columbia University Medical Center, New York, NY, USA.
authors.forename: Demetra
authors.initials: D
authors.lastname: Tsapepas
authors.affiliation: Department of Pharmacy, Hygeia Hospital Athens, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papachristos
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Pharmacy, Hartford Hospital, Hartford, CT, USA.
authors.forename: Spencer
authors.initials: S
authors.lastname: Martin
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, Columbia University Medical Center, New York, NY, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hardy
authors.affiliation: Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: McKeen
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants
keywords: direct oral anticoagulants; drug-drug interactions; renal dysfunction; renal transplant; safety; transplantation