Direct oral anticoagulants versus Vitamin K antagonist in kidney transplant recipients with atrial fibrillation: A study from a global federated research network
Abstract
Background
The risk-benefit profile of direct oral anticoagulants (DOACs) in kidney transplant recipients (KTRs) with atrial fibrillation (AF) remains under-investigated.
Purpose
To evaluate the safety and efficacy of DOACs compared with vitamin K antagonists (VKAs) in KTRs with AF.
Methods
Retrospective analysis from TriNetX network. Adult KTRs with AF were included. Patients with mechanical valves, antiphospholipid syndrome, or an estimated eGFR <15 mL/min/1.73 m² were excluded. Anticoagulated patients were stratified into two cohorts (DOACs versus VKAs) . The first 3 months post-transplant were excluded, and follow-up for outcomes started at 9 months post-transplant and continued for 12 months thereafter. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was a composite of all-cause death, thromboembolic events, major bleeding. Secondary outcomes included each component of the composite outcome and kidney transplant rejection.
Results
Of the 1367 KTRs with AF, 695 received DOACs (65.0 ± 10.0 years, 30.5% female), while 672 received VKAs (64.0 ± 10.1 years, 29.9% female). After matching, each cohort included 553 patients. At one-year follow-up, compared with VKAs, DOACs were associated with a lower risk of the composite outcome (HR 0.66, 95%CI 0.50–0.87), and kidney transplant rejection (HR 0.46, 95%CI 0.30–0.71). A non-significant trend was observed toward a lower risk of all-cause death (HR 0.64, 95%CI 0.41–1.01), major bleeding (HR 0.66, 95%CI 0.43–1.01), thromboembolic events (HR 0.68, 95%CI 0.43–1.07).
Conclusion
In this real-world cohort of KTRs with AF, DOACs use was associated with lower risk of the composite outcome and kidney transplant rejection.
ABSTRACT
Background
Data on adverse events in patients developing atrial fibrillation (AF) after cardiac arrest (CA)…
Abstract
Background
The risk-benefit profile of direct oral anticoagulants (DOACs) in kidney transplant recipients (KTRs) with atrial fibrillation (AF)…
Background
Chronic pericarditis is associated with significant cardiovascular morbidity, including atrial fibrillation (AF), heart failure (HF), and stroke. Colchicine is widely used in…