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<p>Direct oral anticoagulants (DOACs) including apixaban are often utilized in patients with end-stage renal disease (ESRD) awaiting kidney transplantation, but the unpredictable timing of deceased donor kidney transplantation (DDKT) complicates peri-operative management. This case series aims to explore the efficacy and safety outcomes associated with four-factor prothrombin complex concentrate (4&#xa0;F-PCC) use to induce hemostasis prior to DDKT for Veterans taking apixaban. We retrospectively reviewed Veterans who underwent DDKT between November 2020 to October 2023 with confirmed apixaban use within 48&#xa0;h prior. All received weight-based 4&#xa0;F-PCC at doses of 25–50 units/kg before transplantation. Hemostatic efficacy, categorized as excellent, good, or poor based on hemoglobin changes and transfusion requirements, served as the primary outcome. Secondary outcomes included estimated blood loss, return to operation room, 30-day thromboembolic events, and 30-day all-cause mortality. Among 14 Veterans (mean age 65 years; 92.9% male), 10 (71.4%) achieved excellent or good hemostasis. The mean estimated blood loss was 181.2 ± 66.8 mL. One Veteran required re-operation for hematoma. Two deaths occurred within 30 days, including one death with pulmonary embolism identified on autopsy. Although 4&#xa0;F-PCC may support hemostasis for apixaban reversal prior to DDKT, the thromboembolic event observed in this series highlight the need for further evaluation of safety outcomes and criteria for reversal in the DDKT population.</p>

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Four-factor prothrombin complex concentrate for the reversal of apixaban prior to deceased donor kidney transplant: A case series

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Michelle S. Dierker,
  • Anne Przybylski,
  • Laura Cotiguala,
  • Reynold Lopez-Soler,
  • Kaitlin Ferguson

摘要

Direct oral anticoagulants (DOACs) including apixaban are often utilized in patients with end-stage renal disease (ESRD) awaiting kidney transplantation, but the unpredictable timing of deceased donor kidney transplantation (DDKT) complicates peri-operative management. This case series aims to explore the efficacy and safety outcomes associated with four-factor prothrombin complex concentrate (4 F-PCC) use to induce hemostasis prior to DDKT for Veterans taking apixaban. We retrospectively reviewed Veterans who underwent DDKT between November 2020 to October 2023 with confirmed apixaban use within 48 h prior. All received weight-based 4 F-PCC at doses of 25–50 units/kg before transplantation. Hemostatic efficacy, categorized as excellent, good, or poor based on hemoglobin changes and transfusion requirements, served as the primary outcome. Secondary outcomes included estimated blood loss, return to operation room, 30-day thromboembolic events, and 30-day all-cause mortality. Among 14 Veterans (mean age 65 years; 92.9% male), 10 (71.4%) achieved excellent or good hemostasis. The mean estimated blood loss was 181.2 ± 66.8 mL. One Veteran required re-operation for hematoma. Two deaths occurred within 30 days, including one death with pulmonary embolism identified on autopsy. Although 4 F-PCC may support hemostasis for apixaban reversal prior to DDKT, the thromboembolic event observed in this series highlight the need for further evaluation of safety outcomes and criteria for reversal in the DDKT population.