Burroughs Kristina M, Lichvar Alicia B, Groetzinger Lara M, Horn Edward, Iasella Carlo J, Moore Cody A, Pierce Dana R, Sacha Lauren M, Rivosecchi Ryan M
Inova Fairfax Hospital, Falls Church, VA, USA.
University of California, Irvine, Orange, CA, USA.
J Pharm Technol. 2025 Jun 30:87551225251348830. doi: 10.1177/87551225251348830.
Patients undergoing transplantation experience higher rates of venous thromboembolism and non-valvular atrial fibrillation (NVAF) compared with the general population. Anticoagulation decisions in this patient population are complex. A national survey on direct-acting oral anticoagulant practices demonstrated significant heterogeneity, in the setting of drug-drug interactions. The aim of this study was to evaluate the anticoagulation practices of clinicians caring for solid organ transplant patients. A 15-question survey consisting of 7 demographic questions and 8 unique patient cases was distributed via email Listserv of several professional transplantation organizations. Each case question asked the participant to select an anticoagulant regimen depending on: (1) indication for anticoagulation, (2) renal function, and (3) drug-drug interactions. Participants selected one of the following options: apixaban, dabigatran, enoxaparin, rivaroxaban, warfarin, or write in an alternative option. Descriptive statistics were used to analyze survey results. Fifty participants completed 4 or more (≥50%) of the case-based survey questions and were included in the analysis. Ninety-four percent of participants were pharmacists, representing 43 transplant centers. Fifty-one percent of responders preferred warfarin for the indication of NVAF. Apixaban was preferred in patients with new or previous deep vein thrombosis/pulmonary embolism (51%). Fifty-four percent of respondents preferred warfarin in questions in renal dysfunction. In scenarios involving a mild-moderate CYP3A4 inhibitor azole antifungal, 61% of respondents preferred apixaban, with 64% of those selecting a standard dose regimen (vs a reduced dose regimen). Participants preferred warfarin (57%) in scenarios with a strong CYP3A4 inhibitor. The results of our survey demonstrated a high degree of variation when selecting anticoagulation strategies in complex clinical scenarios involving transplant patients.
与普通人群相比，接受移植的患者发生静脉血栓栓塞和非瓣膜性心房颤动（NVAF）的几率更高。该患者群体的抗凝决策很复杂。一项关于直接口服抗凝剂使用情况的全国性调查显示，在药物相互作用的情况下存在显著异质性。本研究的目的是评估照顾实体器官移植患者的临床医生的抗凝实践。通过几个专业移植组织的电子邮件列表分发了一份包含15个问题的调查问卷，其中包括7个人口统计学问题和8个独特的患者病例。每个病例问题要求参与者根据以下因素选择抗凝方案：（1）抗凝指征，（2）肾功能，以及（3）药物相互作用。参与者从以下选项中选择其一：阿哌沙班、达比加群、依诺肝素、利伐沙班、华法林，或填写其他选项。使用描述性统计分析调查结果。50名参与者完成了4个或更多（≥50%）基于病例的调查问题，并被纳入分析。94%的参与者是药剂师，代表43个移植中心。51%的受访者在NVAF指征方面首选华法林。在有新发或既往深静脉血栓形成/肺栓塞的患者中，阿哌沙班更受青睐（51%）。54%的受访者在肾功能不全的问题中首选华法林。在涉及轻度至中度CYP3A4抑制剂唑类抗真菌药的情况下，61%的受访者首选阿哌沙班，其中64%的人选择标准剂量方案（与减少剂量方案相比）。在有强效CYP3A4抑制剂的情况下，参与者首选华法林（57%）。我们的调查结果表明，在涉及移植患者的复杂临床场景中选择抗凝策略时存在高度差异。
