Key result
Initiating rivaroxaban or apixaban does not alter tacrolimus troughs or daily doses in transplant recipients.
Why the study?
The solid organ transplant community has been slow to adopt direct oral anticoagulants because rivaroxaban and apixaban share common metabolic pathways with tacrolimus, leaving their impact on tacrolimus troughs unclear.
Does the initiation of rivaroxaban or apixaban affect tacrolimus trough levels in solid organ transplant recipients?
Observational (n=50)
Does the initiation of rivaroxaban or apixaban affect tacrolimus trough levels in solid organ transplant recipients?
Absolute Event Rate: 2.16% vs 2.15%
Initiation of rivaroxaban or apixaban in solid organ transplant recipients does not significantly alter tacrolimus trough levels, suggesting no need for preemptive tacrolimus dose adjustments.
May support unchanged tacrolimus dosing with these NOACs; leaves open prospective confirmation in transplant recipients.
The solid organ transplant community is slow to adopt the routine practice of using direct oral anticoagulants. Rivaroxaban and apixaban share common metabolic pathways with tacrolimus. This study aimed to clarify the impact of rivaroxaban/apixaban on tacrolimus troughs. Fifty solid organ transplant recipients with concomitant use of tacrolimus and rivaroxaban/apixaban were retrospectively assessed for changes in tacrolimus troughs and dose. Average dose-adjusted tacrolimus troughs and average tacrolimus total daily doses prior to and after rivaroxaban/apixaban initiation were compared. Subgroup analyses evaluating rivaroxaban and apixaban individually were performed. Rivaroxaban was prescribed to 18 recipients, and apixaban was prescribed to 32 recipients. Transplanted organs included kidney (n = 22), lung (n = 18), liver (n = 7), simultaneous pancreas and kidney (n = 1), and simultaneous kidney and liver (n = 2). The median doseadjusted tacrolimus trough and tacrolimus total daily dose prior to rivaroxaban/apixaban initiation was 2.15 ng/mL/mg (IQR 1.17, 3.37) and 4 mg (IQR 1.88, 6.25), respectively. The median dose-adjusted tacrolimus trough and tacrolimus total daily dose after rivaroxaban/apixaban initiation was 2.16 ng/mL/mg (IQR 1.24, 4.10) and 3.55 mg (IQR 1.5, 6.35), respectively. No significant difference was found between average dose-adjusted tacrolimus troughs or tacrolimus total daily doses before and after rivaroxaban/apixaban initiation or in the individual subgroup analyses for rivaroxaban/apixaban. It is unlikely that initiating rivaroxaban/apixaban affects tacrolimus troughs or requires tacrolimus dose adjustment. This study does not elucidate if tacrolimus affects rivaroxaban/apixaban pharmacokinetics or pharmacodynamics.
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Scheibner et al. (2021) conducted an observational in Solid organ transplant (n=50). Rivaroxaban or apixaban vs. Prior to rivaroxaban/apixaban initiation was evaluated on Dose-adjusted tacrolimus trough (ng/mL/mg). Initiating rivaroxaban or apixaban in solid organ transplant recipients did not significantly change median dose-adjusted tacrolimus troughs (2.16 vs 2.15 ng/mL/mg) or total daily doses.
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