Comparison of warfarin and direct oral anticoagulants in kidney transplant recipients: Safety and efficacy outcomes

AIM: The safety and efficacy of warfarin vs. those of direct oral anticoagulants (DOACs) in kidney transplant (KT) recipients are unclear. Therefore, anticoagulation therapy outcomes in KT recipients were compared. MATERIALS AND METHODS: This retrospective study included 57 KT recipients on outpatient anticoagulation therapy at Ulsan University Hospital between July 1998 and May 2021. Major bleeding, thromboembolic events, and mortality were compared between warfarin and DOAC groups. Kaplan-Meier plot and Cox regression were used to assess between-group differences. RESULTS: Median follow-up was 140 months for the warfarin group and 92.5 months for the DOAC group. No significant differences were observed for baseline characteristics between the warfarin (n = 33) and DOAC (n = 24) groups, except for atrial fibrillation or flutter. No significant differences were observed in major bleeding, thromboembolic events, or mortality. Kaplan-Meier analysis also showed no group differences in these outcomes. In multivariable Cox regression, age and sex were significantly associated with major bleeding, whereas thromboembolic events were higher in the DOAC group. CONCLUSION: Major bleeding and mortality rates were comparable; however, thromboembolic events were more frequent in the DOAC group. Further research on DOAC subtypes, drug interactions, and dosing is warranted.