DOACs safe for kidney transplant recipients

Among kidney transplant recipients, the risk of bleeding is comparable between patients treated with warfarin and those treated with direct oral anticoagulants (DOACs), a study has shown.

However, patients in the warfarin group required higher volumes of blood products and had longer hospital length of stays.

A team of investigators conducted this single-centre, retrospective, cohort study and assessed 67 patients on either a DOAC (n=28) or warfarin (n=39) prior to kidney transplantation.

The primary outcome was a composite of perioperative bleeding risk at 30 days of major bleeding and clinically relevant nonmajor bleeding. Secondary outcomes included the incidence of type of bleeds, thromboembolism, hospital length of stay, blood product receipt, and patient/graft survival.

No significant difference was observed in the primary outcome between the DOAC and warfarin groups (21.4 percent vs 28.2 percent; p=0.52).

More patients treated with warfarin met the criteria for major bleeding (20.5 percent vs 14.3 percent; p=0.13), but this did not reach statistical significance. Minor bleeds were similar between groups (7.7 percent vs 7.1 percent; p=0.99).

Notably, warfarin-treated patients had a longer length of hospital stay than those on DOACs (median 8 vs 5 days; p<0.0001). No differences were observed in the other outcomes.

“This study supports DOAC use in the perioperative setting for kidney transplant recipients,” the investigators said.

DOACs are used for the treatment or prevention of thromboembolism.