Abstract 411 Use of oral anticoagulants in patients after heart transplantation – comparison between vitamin K antagonists and direct oral anticoagulants

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Use of oral anticoagulants in patients after heart transplantation – comparison between vitamin K antagonists and direct oral anticoagulants
L. C. Fabricius¹, A.-K. Rahm¹, M. Helmschrott¹, F. F. Darche¹, P. Ehlermann¹, T. Bruckner², W. Sommer³, G. Warnecke³, N. Frey¹, R. Rivinius¹
¹Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; ²Medizinische Biometrie, Institut für Medizinische Biometrie, Heidelberg; ³Klinik für Herzchirurgie, Universitätsklinikum Heidelberg, Heidelberg;
Aims: Patients after heart transplantation (HTX) often require an oral anticoagulant (OAC) due to atrial arrhythmias or thromboembolic events but little is known about the use of direct oral anticoagulants (DOACs) in comparison to vitamin K antagonists (VKAs) in HTX recipients. We therefore performed the largest known study so far about the use of OACs in patients after HTX comparing DOACs and VKAs. Methods: This study investigated the frequency, indications, and complications of OACs after HTX. We screened all adult patients for use of post-transplant OAC who underwent HTX at Heidelberg Heart Center between 2000 and 2021. Patients were stratified by OAC (DOAC or VKA) and type of DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban). Indications for OAC comprised atrial arrhythmias, pulmonary embolism, deep vein thrombosis, and intracardiac thrombus. Patients with mechanical valves after HTX were excluded. Results: A total of 115 HTX recipients were included, of whom 60 patients received DOACs (52.2%) and 55 patients received VKAs (47.8%). Concerning DOACs, 28 patients were treated with rivaroxaban (46.7%), 27 patients with apixaban (45.0%), and 5 patients with edoxaban (8.3%). No patient received dabigatran due to potential interactions. There were no statistically signiﬁcant differences between both groups regarding demographics, immunosuppressive drugs, concomitant medications, or indications for OAC. In terms of complications, we found no statistically significant differences between HTX recipients with DOACs or VKAs in rates of ischemic stroke (3.3% versus 3.6%, P = 0.929), thromboembolic events (3.3% versus 1.8%, P = 0.611), or OAC-related death (1.7% versus 3.6%, P = 0.508). Patients with DOACs had a significantly lower rate of overall bleeding complications (10.0% versus 32.7%, P = 0.003) and gastrointestinal hemorrhage (6.7% versus 21.8%, P = 0.019) requiring fewer transfusions of packed red blood cells after HTX (10.0% versus 29.1%, P = 0.009). Conclusions: Use of DOACs in HTX recipients appears to be comparable to VKAs regarding the risk of ischemic stroke, thromboembolic events, or OAC-related death but seems to be associated with fewer bleeding complications. Keywords: atrial fibrillation, bleeding, direct oral anticoagulant, heart transplantation, oral anticoagulant, stroke, vitamin K antagonist
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