Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants

Darche, Fabrice F.; Fabricius, Lisa C.; Helmschrott, Matthias; Rahm, Ann-Kathrin; Ehlermann, Philipp; Bruckner, Tom; Sommer, Wiebke; Warnecke, Gregor; Frey, Norbert; Rivinius, Rasmus

doi:10.3390/jcm12134334

Cited by 2 publications

(1 citation statement)

References 45 publications

(197 reference statements)

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“…Step by step process of study selection is depicted in Fig- 1. Eight studies 3,6,[12][13][14][15][16][17] comparative safety and efficacy of direct-acting oral anticoagulants (DOACs were found eligible for this review. Details are shown in Table-I.…”

Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and meta-analysis

He,

Yao

2024

Pak J Med Sci

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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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Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and meta-analysis

He,

Yao

2024

Pak J Med Sci

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Early Pacemaker Dependency After Heart Transplantation Is Associated with Permanent Pacemaker Implantation, Graft Failure and Mortality

Darche,

Heil,

Rivinius

et al. 2024

JCDD

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Aims: Patients after heart transplantation (HTX) often experience post-transplant bradycardia, but little is known about the outcomes of early pacemaker dependency after HTX. We compared post-transplant mortality, graft failure, and the requirement for the permanent pacemaker implantation of patients with and without early pacemaker dependency after HTX. Methods: We screened all adult patients for early pacemaker dependency after HTX (defined as immediately after surgery) who underwent HTX at Heidelberg Heart Center between 1989 and 2022. Patients were stratified by diagnosis and type of early pacemaker dependency after HTX (sinoatrial or atrioventricular conduction disturbance). Results: A total of 127 of 699 HTX recipients (18.2%) had early pacemaker dependency after HTX, including 52 patients with sinoatrial conduction disturbances (40.9%) and 75 patients with atrioventricular conduction disturbances (59.1%). Patients with early pacemaker dependency after HTX showed both increased 1-year overall mortality after HTX (55.9% vs. 15.2%, p < 0.001) and higher mortality due to graft failure (25.2% vs. 4.2%, p < 0.001). Multivariate analysis revealed early pacemaker dependency after HTX (HR: 5.226, 95% CI: 3.738–7.304, p < 0.001) as an independent risk factor for 1-year mortality after HTX. Patients with early pacemaker dependency after HTX had a higher rate of 30-day (7.1% vs. 0.4%, p < 0.001) and 1-year (11.8% vs. 0.5%, p < 0.001) permanent pacemaker implantation after HTX compared to patients without early pacemaker dependency after HTX. Conclusions: Patients with early pacemaker dependency after HTX had a significantly higher rate of post-transplant mortality, graft failure, and the requirement for permanent pacemaker implantation.

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Oral Anticoagulants after Heart Transplantation—Comparison between Vitamin K Antagonists and Direct Oral Anticoagulants

Cited by 2 publications

References 45 publications

Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and meta-analysis

Direct oral anticoagulants vs Vitamin-K antagonists in solid organ transplant recipients: A systematic review and meta-analysis

Early Pacemaker Dependency After Heart Transplantation Is Associated with Permanent Pacemaker Implantation, Graft Failure and Mortality

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