Key result
Transplant clinician survey reveals heterogeneous anticoagulant strategies, with only 70% following standard DOAC dosing.
Why the study?
Anticoagulation decisions in transplant patients are complex given high rates of thromboembolism and NVAF, and prior surveys showed significant practice heterogeneity regarding drug-drug interactions.
How do concomitant azole antifungals, renal dysfunction, and specific indications affect anticoagulant prescribing practices among clinicians caring for solid organ transplant patients?
Cross-Sectional (n=50)
Yes
How do concomitant azole antifungals, renal dysfunction, and specific indications affect anticoagulant prescribing practices among clinicians caring for solid organ transplant patients?
There is significant heterogeneity in anticoagulant selection and DOAC dosing among transplant clinicians, particularly in complex scenarios involving drug-drug interactions and renal dysfunction.
Answers are grounded in this paper and cite their sources.
May warrant caution with DOAC dosing in transplant patients; leaves open optimal strategies pending prospective trials.
Background: Patients undergoing transplantation experience higher rates of venous thromboembolism and non-valvular atrial fibrillation (NVAF) compared with the general population. Anticoagulation decisions in this patient population are complex. A national survey on direct-acting oral anticoagulant practices demonstrated significant heterogeneity, in the setting of drug-drug interactions. Objective: The aim of this study was to evaluate the anticoagulation practices of clinicians caring for solid organ transplant patients. Methods: A 15-question survey consisting of 7 demographic questions and 8 unique patient cases was distributed via email Listserv of several professional transplantation organizations. Each case question asked the participant to select an anticoagulant regimen depending on: (1) indication for anticoagulation, (2) renal function, and (3) drug-drug interactions. Participants selected one of the following options: apixaban, dabigatran, enoxaparin, rivaroxaban, warfarin, or write in an alternative option. Descriptive statistics were used to analyze survey results. Results: Fifty participants completed 4 or more (≥50%) of the case-based survey questions and were included in the analysis. Ninety-four percent of participants were pharmacists, representing 43 transplant centers. Fifty-one percent of responders preferred warfarin for the indication of NVAF. Apixaban was preferred in patients with new or previous deep vein thrombosis/pulmonary embolism (51%). Fifty-four percent of respondents preferred warfarin in questions in renal dysfunction. In scenarios involving a mild-moderate CYP3A4 inhibitor azole antifungal, 61% of respondents preferred apixaban, with 64% of those selecting a standard dose regimen (vs a reduced dose regimen). Participants preferred warfarin (57%) in scenarios with a strong CYP3A4 inhibitor. Conclusion and Relevance: The results of our survey demonstrated a high degree of variation when selecting anticoagulation strategies in complex clinical scenarios involving transplant patients.
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Burroughs et al. (2025) conducted a cross-sectional in Clinicians caring for solid organ transplant patients (n=50). Clinical scenarios involving varying indications, renal function, and drug-drug interactions was evaluated on Clinical practice of anticoagulant selection and DOAC dosing across transplant pharmacists. A national survey of 50 transplant clinicians demonstrated significant heterogeneity in anticoagulant selection and dosing strategies for complex clinical scenarios, with only 70% of DOAC selections adhering to package insert dosing.
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