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Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants

Aims: Patients after heart transplantation (HTX) often require oral anticoagulants (OACs) due to atrial arrhythmias or thromboembolic events but little is known about the post-transplant use of direct oral anticoagulants (DOACs). We investigated the frequency, indications, and complications of DOACs...

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Autores principales: Darche, Fabrice F., Fabricius, Lisa C., Helmschrott, Matthias, Rahm, Ann-Kathrin, Ehlermann, Philipp, Bruckner, Tom, Sommer, Wiebke, Warnecke, Gregor, Frey, Norbert, Rivinius, Rasmus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342416/
https://www.ncbi.nlm.nih.gov/pubmed/37445369
http://dx.doi.org/10.3390/jcm12134334
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author Darche, Fabrice F.
Fabricius, Lisa C.
Helmschrott, Matthias
Rahm, Ann-Kathrin
Ehlermann, Philipp
Bruckner, Tom
Sommer, Wiebke
Warnecke, Gregor
Frey, Norbert
Rivinius, Rasmus
author_facet Darche, Fabrice F.
Fabricius, Lisa C.
Helmschrott, Matthias
Rahm, Ann-Kathrin
Ehlermann, Philipp
Bruckner, Tom
Sommer, Wiebke
Warnecke, Gregor
Frey, Norbert
Rivinius, Rasmus
author_sort Darche, Fabrice F.
collection PubMed
description Aims: Patients after heart transplantation (HTX) often require oral anticoagulants (OACs) due to atrial arrhythmias or thromboembolic events but little is known about the post-transplant use of direct oral anticoagulants (DOACs). We investigated the frequency, indications, and complications of DOACs and vitamin K antagonists (VKAs) after HTX. Methods: We screened all adult patients for the use of post-transplant OACs who underwent HTX at Heidelberg Heart Center between 2000 and 2021. Patients were stratified by type of OAC (DOAC or VKA) and by DOAC agents (apixaban, dabigatran, edoxaban, or rivaroxaban). Indications for OACs comprised atrial fibrillation, atrial flutter, pulmonary embolism, upper and lower extremity deep vein thrombosis, as well as intracardiac thrombus. Results: A total of 115 of 459 HTX recipients (25.1%) required OACs, including 60 patients with DOACs (52.2%) and 55 patients with VKAs (47.8%). Concerning DOACs, 28 patients were treated with rivaroxaban (46.7%), 27 patients with apixaban (45.0%), and 5 patients with edoxaban (8.3%). We found no significant differences between both groups concerning demographics, immunosuppressive drugs, concomitant medications, indications for OACs, ischemic stroke, thromboembolic events, or OAC-related death. Patients with DOACs after HTX had a significantly lower one-year rate of overall bleeding complications (p = 0.002) and a significantly lower one-year rate of gastrointestinal hemorrhage (p = 0.011) compared to patients with VKAs after HTX in the Kaplan–Meier estimator. Conclusions: DOACs were comparable to VKAs concerning the risk of ischemic stroke, thromboembolic events, or OAC-related death but were associated with significantly fewer bleeding complications in HTX recipients.
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spelling pubmed-103424162023-07-14 Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants Darche, Fabrice F. Fabricius, Lisa C. Helmschrott, Matthias Rahm, Ann-Kathrin Ehlermann, Philipp Bruckner, Tom Sommer, Wiebke Warnecke, Gregor Frey, Norbert Rivinius, Rasmus J Clin Med Article Aims: Patients after heart transplantation (HTX) often require oral anticoagulants (OACs) due to atrial arrhythmias or thromboembolic events but little is known about the post-transplant use of direct oral anticoagulants (DOACs). We investigated the frequency, indications, and complications of DOACs and vitamin K antagonists (VKAs) after HTX. Methods: We screened all adult patients for the use of post-transplant OACs who underwent HTX at Heidelberg Heart Center between 2000 and 2021. Patients were stratified by type of OAC (DOAC or VKA) and by DOAC agents (apixaban, dabigatran, edoxaban, or rivaroxaban). Indications for OACs comprised atrial fibrillation, atrial flutter, pulmonary embolism, upper and lower extremity deep vein thrombosis, as well as intracardiac thrombus. Results: A total of 115 of 459 HTX recipients (25.1%) required OACs, including 60 patients with DOACs (52.2%) and 55 patients with VKAs (47.8%). Concerning DOACs, 28 patients were treated with rivaroxaban (46.7%), 27 patients with apixaban (45.0%), and 5 patients with edoxaban (8.3%). We found no significant differences between both groups concerning demographics, immunosuppressive drugs, concomitant medications, indications for OACs, ischemic stroke, thromboembolic events, or OAC-related death. Patients with DOACs after HTX had a significantly lower one-year rate of overall bleeding complications (p = 0.002) and a significantly lower one-year rate of gastrointestinal hemorrhage (p = 0.011) compared to patients with VKAs after HTX in the Kaplan–Meier estimator. Conclusions: DOACs were comparable to VKAs concerning the risk of ischemic stroke, thromboembolic events, or OAC-related death but were associated with significantly fewer bleeding complications in HTX recipients. MDPI 2023-06-28 /pmc/articles/PMC10342416/ /pubmed/37445369 http://dx.doi.org/10.3390/jcm12134334 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Darche, Fabrice F.
Fabricius, Lisa C.
Helmschrott, Matthias
Rahm, Ann-Kathrin
Ehlermann, Philipp
Bruckner, Tom
Sommer, Wiebke
Warnecke, Gregor
Frey, Norbert
Rivinius, Rasmus
Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title_full Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title_fullStr Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title_full_unstemmed Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title_short Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants
title_sort oral anticoagulants after heart transplantation—comparison between vitamin k antagonists and direct oral anticoagulants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342416/
https://www.ncbi.nlm.nih.gov/pubmed/37445369
http://dx.doi.org/10.3390/jcm12134334
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