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Santoro F, Casanova A, Simone S, Alfieri C, Falcone A, Dello Strologo A, Grandinetti V, Busutti M, Comai G, Marvulli TM, Zippo MG, Castellano G, La Manna G, Gesualdo L, Giuseppe G, Pesce F. Immunosuppressive therapy and oral anticoagulation in kidney transplant recipients: Direct oral anticoagulants versus vitamin-k antagonists. Eur J Intern Med 2024; 119:71-77. [PMID: 37573220 DOI: 10.1016/j.ejim.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND direct oral anticoagulants (DOACs) are an alternative to conventional antagonist of vitamin-K (AVK). However, immune suppressive drugs (ISDs) may interfere with DOACs pharmacokinetic. AIM OF THIS STUDY evaluate safety and efficacy profile of DOACs compared to AVK in kidney transplant recipients (KTRs) treated with ISDs. METHODS a multi-center study from 4 Italian University hospitals enrolling consecutive KTRs on DOACs or AVK was carried out. Sixty-six patients on DOACs were compared with fifty patients on AVK with similar clinical features. Serial evaluation of renal function and serum levels of ISDs during 18 months follow-up (FU) was performed. RESULTS Mean age of DOACs patients was 67±9 and mean eGFR was 58,3± 30,4mL/min/1.73m2. ISDs included tacrolimus (n=47, 71%), cyclosporin (n=13, 20%), everolimus (n=10, 7%) and sirolimus (n=4, 6%). After 14 days of DOACs therapy initiation there was a slight increase of serum levels of tacrolimus (+0.19±0.67 p=0.80) and cyclosporine (+0.12±0.25 p=0.94) not statistically significant. Levels of Tacrolimus and cyclosporin were stable at serial evaluation during 18-months follow-up. There were no thromboembolic events among patients treated with DOACs or AVK and no differences in term of major bleeding (6% vs 4% p=0.69), at long-term follow-up. There was no difference in term of eGFR decline from start therapy to 18 months FU between DOACs vs AVK therapy (-3.9±1 vs -3.8±2 p=0.82). CONCLUSION DOACs have similar safety and efficacy than AVK among KTRs treated with ISDs. However, careful evaluation of potential drug interaction and ISDs serum levels is needed.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical sciences, University of Foggia, Italy;.
| | - Annalisa Casanova
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Carlo Alfieri
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Adele Falcone
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Andrea Dello Strologo
- Department of Translational Medicine and Surgery, University Cattolica Sacro Cuore, Rome, Italy;.
| | - Valeria Grandinetti
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Marco Busutti
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tommaso Maria Marvulli
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Maria Grazia Zippo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Giuseppe Castellano
- Department of Clinical Sciences and Community Health, University of Milan, Italy;; Unit of Nephrology Dialysis and Renal Transplantation, IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of medical and surgery sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "A. Moro", Bari, Italy;.
| | - Grandaliano Giuseppe
- Department of Translational Medicine and Surgery, University Cattolica Sacro Cuore, Rome, Italy;; Nephrology Unit, Dept. of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS.
| | - Francesco Pesce
- Division of Renal Medicine, "Fatebenefratelli Isola Tiberina-Gemelli Isola", Rome, Italy.
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A Review of Direct-acting Oral Anticoagulants and Their Use in Solid Organ Transplantation. Transplantation 2022; 106:2143-2154. [PMID: 35642975 DOI: 10.1097/tp.0000000000004195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Direct-acting oral anticoagulant (DOAC) use has increased dramatically since their introduction because of the growing evidence of proven efficacy and enhanced safety compared with warfarin and the low-molecular-weight heparins in the general population. Unfortunately, there is a dearth of quality data regarding the safety and efficacy of the DOACs in patients awaiting organ transplant and those who received a solid organ transplant. This review aims to evaluate the available literature and considerations regarding anticoagulation use in transplant recipients, focusing on preoperative, perioperative, and postoperative DOAC use.
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