#1279 Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Renal Transplant Recipients with Atrial Fibrillation

Abstract Background and Aims Atrial fibrillation (AF) is associated with increased stroke and bleeding risk in patients with chronic kidney disease (CKD) including renal transplant recipients (RTRs). Little is known about the real-life use of non-vitamin K antagonist oral anticoagulants (NOACs) in RTRs. Method In a retrospective cohort study conducted in one academic transplant center, we enrolled consecutive 168 RTRs with AF on NOACs including 139 (82.7%) subjects on apixaban 5 or 10 mg/day, 18 (10.7%) on rivaroxaban 15 or 20 mg/day, 6 (3.6%) subjects on edoxaban 30 mg/day and 5 patients (3.0%) firstly treated with rivaroxaban and then switched to apixaban. Thromboembolic (stroke, transient ischemic attack, systolic embolism) and bleeding events (major and clinically relevant non-major bleeding) were recorded during a median follow-up of 21.2 months. There were no significant differences in demographic, clinical, and laboratory variables at baseline between the 3 treatment groups (Fig. 1). Results During follow-up, arterial thromboembolic events occurred in 9 (6.3%) subjects on apixaban and 4 (18.2%) on rivaroxaban. Patients treated with rivaroxaban did not have a significantly higher hazard of arterial thromboembolic events when compared with those on apixaban (hazard ratio [HR] 2.04; 95% CI: 0.68-6.12, p=0.21). Major bleeding or clinically relevant non-major bleeding occurred in 17 (11.8%) patients receiving apixaban (one experienced both events), 3 (13.0%) patients on rivaroxaban, and 2 (33.3%) on edoxaban. When compared to apixaban, the other NOACs did not significantly differ in the hazard of bleeding [rivaroxaban: HR 0.79 (95% CI: 0.24-2.58; p=0.69); edoxaban: HR 1.90 (95% CI: 0.35-10.27; p=0.46)]. Conclusion The study suggests that RTRs with AF receiving apixaban and rivaroxaban have a similar risk of thromboembolism and bleeding in the everyday practice of the academic transplantation center. Edoxaban was rarely chosen in this group of patients, therefore evidence is uncertain.