Should patients who are listed on a waiting list for solid organ transplantation continue NOAC anticoagulation or should it be changed to VKA? What is your practice? I could not find recommendations, however, In a subanalysis of RE-LY study risk of bleeding after the urgent operations were not higher in Dabigatran arm which should suppose that this is not necessary. For other NOAC I didn't find data about periprocedural bleeding with no discontinuation of the therapy during emergency surgery.
If you are talking about Kidney transplantation, there is no problem:
- Dabigatran could not be used in case of end stage renal disease with a a clearance under 30ml/min
- Rivaroxaban could neither be used with a clearance under 15ml/min
The only situation which can be a problem is in case of preemptive kidney transplantation, but I will not proceed such a case under NOAC...
All DOACs should not be used in patients with end stage kidney / liver disease. In patients who are on waiting list for heart transplantation, dabigatran seems to be acceptable because the antidote (idarucizumab) is available. The antidote of f. Xa inhibitors (andexanet) is also available in some countries, but its effectivity is time-limited, so dabigatran is probably a better choice.
Thank for answers. I am talking about lung and hart transplantation. Our policy is to change NOAC for VKA, which I think is not necessary, surely in case of dabigatran, and put the patient on added risk.