Shitanishi Lauren, Fan Ashley, Khuu Tam, Vucicevic Darko, Kamath Megan, J Hsu Jeffrey, Klomhaus Alexandra, Ardehali Reza
University of California Los Angeles Medical Center, Los Angeles, California.
Baylor College of Medicine, Department of Medicine, Section of Cardiology, Houston, Texas.
JHLT Open. 2024 Jan 24;4:100061. doi: 10.1016/j.jhlto.2024.100061. eCollection 2024 May.
Direct oral anticoagulants (DOACs) have transformed the field of anticoagulation, offering more predictable pharmacokinetic and pharmacodynamic characteristics when compared to traditional warfarin therapy. DOAC use in the heart transplant population is particularly important to further study due to the high risk of venothromboembolism and the potential for significant drug interactions and altered pharmacokinetics post-transplantation.
A single center, retrospective cohort study was performed in adult heart transplant recipients requiring anticoagulation following transplantation between January 2010 and July 2021. Primary outcomes included incidence of bleeding and breakthrough thromboembolic events.
Ninety-five patients met inclusion criteria and out of these patients, 30 (32%) were prescribed warfarin and 65 (68%) were prescribed a DOAC. Seventeen total bleeding events occurred. Bleeding events were significantly more common in the warfarin group compared to the DOAC group (58% vs 41%, = 0.0077). There was a total of 6 breakthrough thrombotic events in this cohort, all of which were patients on DOAC therapy.
DOAC therapy in heart transplant recipients may be safer from a bleeding perspective when compared to warfarin. Additional data to further evaluate the appropriateness for dose modifications for patients with potential drug-drug interactions, higher bleed risk, and unstable renal function are needed to guide optimal practice and dosing strategies in heart transplant recipients.
直接口服抗凝剂（DOACs）改变了抗凝领域，与传统华法林治疗相比，其药代动力学和药效学特征更具可预测性。由于心脏移植人群静脉血栓栓塞风险高，且移植后存在显著药物相互作用和药代动力学改变的可能性，因此进一步研究DOACs在该人群中的应用尤为重要。
对2010年1月至2021年7月期间接受心脏移植后需要抗凝治疗的成年患者进行了一项单中心回顾性队列研究。主要结局包括出血和突破性血栓栓塞事件的发生率。
95例患者符合纳入标准，其中30例（32%）接受华法林治疗，65例（68%）接受DOAC治疗。共发生17次出血事件。与DOAC组相比，华法林组出血事件更为常见（58%对41%，P = 0.0077）。该队列中共有6次突破性血栓形成事件，所有事件均发生在接受DOAC治疗的患者中。
与华法林相比，心脏移植受者使用DOAC治疗在出血方面可能更安全。需要更多数据来进一步评估潜在药物相互作用、出血风险较高和肾功能不稳定患者剂量调整的适宜性，以指导心脏移植受者的最佳实践和给药策略。
