Why the study?
Evidence on the safety and efficacy of direct oral anticoagulants compared with Vitamin K antagonists in solid organ transplant recipients needed to be examined.
Do direct oral anticoagulants reduce bleeding and thromboembolic events compared to Vitamin K antagonists in solid organ transplant recipients?
Do direct oral anticoagulants reduce bleeding and thromboembolic events compared to Vitamin K antagonists in solid organ transplant recipients?
In solid organ transplant recipients, DOACs appear safe and effective, significantly reducing composite bleeding compared to VKAs without increasing the risk of major bleeding, VTE, or ischemic stroke.
Answers are grounded in this paper and cite their sources.
DOACs linked to lower bleeding than VKAs in transplant recipients; supports preferential use but needs RCT confirmation.
Objective: Oure review aimed to examine evidence on the safety and efficacy of direct oral anticoagulants (DOAC) vs Vitamin K antagonists (VKA) in patients with solid organ transplants. Methods: PubMed, Embase, and Web of Science libraries were searched from inception to 25th November 2023 for all studies comparing DOAC with VKA in solid organ recipients. Results: Nine studies were included with patients who had undergone kidney, heart, or liver transplants. Meta-analysis showed that patients receiving DOAC had a significantly reduced risk of composite bleeding as compared to those with VKA (RR: 0.45 95% CI: 0.30, 0.68 I2=25%). However, the risk of major bleeding was not significantly different between the two groups (RR: 0.76 95% CI: 0.40, 1.42 I2=37%). Pooled analysis showed that the risk of VTE (RR: 0.90 95% CI: 0.72, 1.13 I2=0%) and ischemic stroke (RR: 0.87 95% CI: 0.39, 1.94 I2=12%) was not significantly different between DOAC and VKA groups. Conclusion: Limited data shows that DOAC are safe and effective in patients with solid organ transplants. The overall risk of bleeding may be reduced with the use of DOAC. There is a need for randomized controlled trials comparing DOAC and VKA in such patients to obtain high-quality evidence. doi: https://doi.org/10.12669/pjms.40.6.9305 How to cite this: He C, Yao C. Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and meta-analysis. Pak J Med Sci. 2024;40(6):1267-1273. doi: https://doi.org/10.12669/pjms.40.6.9305 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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He et al. (2024) studied this question.
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