Cargando…

Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?

BACKGROUND: Patients undergoing kidney transplantation are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. This study aimed to determine the safety of continuing anticoagulation or antiplatelet therapy prior to kidney transplantation....

Descripción completa

Detalles Bibliográficos
Autores principales: Alonso-Escalante, Jose C., Machado, Lorenzo, Tabar, Kiumars R., Tindall, Rachell, Thai, Ngoc, Uemura, Tadahiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485698/
https://www.ncbi.nlm.nih.gov/pubmed/34580271
http://dx.doi.org/10.12659/AOT.931648
_version_ 1784577587165528064
author Alonso-Escalante, Jose C.
Machado, Lorenzo
Tabar, Kiumars R.
Tindall, Rachell
Thai, Ngoc
Uemura, Tadahiro
author_facet Alonso-Escalante, Jose C.
Machado, Lorenzo
Tabar, Kiumars R.
Tindall, Rachell
Thai, Ngoc
Uemura, Tadahiro
author_sort Alonso-Escalante, Jose C.
collection PubMed
description BACKGROUND: Patients undergoing kidney transplantation are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. This study aimed to determine the safety of continuing anticoagulation or antiplatelet therapy prior to kidney transplantation. The primary outcome was bleeding after transplantation. MATERIAL/METHODS: Patients who underwent kidney transplantation between January 2017 and July 2019 were included and divided into 3 groups: pretransplant anticoagulation with warfarin (WARF; n=23); pretransplant antiplatelet therapy with clopidogrel/aspirin (ASA/CLOP; n=32); and control (CTL; n=197). Patients received kidneys from live or deceased donors. Preoperative INRs and platelet counts were compared to ensure therapeutic anticoagulation in the warfarin group and no significant platelet count variation among groups. The primary outcome was graft exploration for bleeding at 3 and 6 months after transplantation. Secondary outcomes included perioperative transfusion requirements, prolonged length of stay (>7 days), and outcomes at 3 and 6 months after transplantation, including hemodialysis and rejection rates and creatinine levels. RESULTS: Pretransplant INR was significantly greater in the warfarin group (CTL 1.1, WARF 2.2, ASA/CLOP 1.2; P<0.01). There were no differences in pretransplant platelet count (CTL 202×10(3), WARF 186×10(3), ASA/CLOP 194×10(3); P=0.31), graft exploration for bleeding at 3 (CTL 3%, WARF 0%, ASA/CLOP 3%; P=0.69) and 6 months after transplantation (CTL 1%, WARF 4%, ASA/CLOP 0%; P=0.12), or perioperative blood transfusion requirements (CTL 4%, WARF 4%, ASA/CLOP 14%; P=0.13). Prolonged length of stay was similar (CTL 24%, WARF 26%, ASA/CLOP 44%; P=0.08). There were no significant differences among groups at 3 months in dialysis (CTL 2%, WARF 0%, ASA/CLOP 0%; P=0.71), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.7; P=0.13), or rejection (CTL 6%, WARF 0%, ASA/CLOP 0%) or at 6 months in dialysis (CTL 3%, WARF 0%, ASA/CLOP 0%; P=0.49), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.5; P=0.49), or rejection (CTL 1%, WARF 0%, ASA/CLOP 3%). CONCLUSIONS: Continuing anticoagulation or antiplatelet was safe in not increasing bleeding complications or perioperative transfusion requirements. Outcomes were similar at 3 and 6 months among groups. This strategy avoids exposing patients to risk of thrombosis if treatment is held and simplifies proceeding to transplantation.
format Online
Article
Text
id pubmed-8485698
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher International Scientific Literature, Inc.
record_format MEDLINE/PubMed
spelling pubmed-84856982021-10-18 Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation? Alonso-Escalante, Jose C. Machado, Lorenzo Tabar, Kiumars R. Tindall, Rachell Thai, Ngoc Uemura, Tadahiro Ann Transplant Original Paper BACKGROUND: Patients undergoing kidney transplantation are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. This study aimed to determine the safety of continuing anticoagulation or antiplatelet therapy prior to kidney transplantation. The primary outcome was bleeding after transplantation. MATERIAL/METHODS: Patients who underwent kidney transplantation between January 2017 and July 2019 were included and divided into 3 groups: pretransplant anticoagulation with warfarin (WARF; n=23); pretransplant antiplatelet therapy with clopidogrel/aspirin (ASA/CLOP; n=32); and control (CTL; n=197). Patients received kidneys from live or deceased donors. Preoperative INRs and platelet counts were compared to ensure therapeutic anticoagulation in the warfarin group and no significant platelet count variation among groups. The primary outcome was graft exploration for bleeding at 3 and 6 months after transplantation. Secondary outcomes included perioperative transfusion requirements, prolonged length of stay (>7 days), and outcomes at 3 and 6 months after transplantation, including hemodialysis and rejection rates and creatinine levels. RESULTS: Pretransplant INR was significantly greater in the warfarin group (CTL 1.1, WARF 2.2, ASA/CLOP 1.2; P<0.01). There were no differences in pretransplant platelet count (CTL 202×10(3), WARF 186×10(3), ASA/CLOP 194×10(3); P=0.31), graft exploration for bleeding at 3 (CTL 3%, WARF 0%, ASA/CLOP 3%; P=0.69) and 6 months after transplantation (CTL 1%, WARF 4%, ASA/CLOP 0%; P=0.12), or perioperative blood transfusion requirements (CTL 4%, WARF 4%, ASA/CLOP 14%; P=0.13). Prolonged length of stay was similar (CTL 24%, WARF 26%, ASA/CLOP 44%; P=0.08). There were no significant differences among groups at 3 months in dialysis (CTL 2%, WARF 0%, ASA/CLOP 0%; P=0.71), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.7; P=0.13), or rejection (CTL 6%, WARF 0%, ASA/CLOP 0%) or at 6 months in dialysis (CTL 3%, WARF 0%, ASA/CLOP 0%; P=0.49), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.5; P=0.49), or rejection (CTL 1%, WARF 0%, ASA/CLOP 3%). CONCLUSIONS: Continuing anticoagulation or antiplatelet was safe in not increasing bleeding complications or perioperative transfusion requirements. Outcomes were similar at 3 and 6 months among groups. This strategy avoids exposing patients to risk of thrombosis if treatment is held and simplifies proceeding to transplantation. International Scientific Literature, Inc. 2021-09-28 /pmc/articles/PMC8485698/ /pubmed/34580271 http://dx.doi.org/10.12659/AOT.931648 Text en © Ann Transplant, 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Original Paper
Alonso-Escalante, Jose C.
Machado, Lorenzo
Tabar, Kiumars R.
Tindall, Rachell
Thai, Ngoc
Uemura, Tadahiro
Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title_full Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title_fullStr Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title_full_unstemmed Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title_short Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
title_sort is continuing anticoagulation or antiplatelet therapy safe prior to kidney transplantation?
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485698/
https://www.ncbi.nlm.nih.gov/pubmed/34580271
http://dx.doi.org/10.12659/AOT.931648
work_keys_str_mv AT alonsoescalantejosec iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation
AT machadolorenzo iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation
AT tabarkiumarsr iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation
AT tindallrachell iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation
AT thaingoc iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation
AT uemuratadahiro iscontinuinganticoagulationorantiplatelettherapysafepriortokidneytransplantation