Impact of pre-transplant antiaggregant and anticoagulant therapies on early hemorrhagic and cardiovascular events after kidney transplantation

Background: Oral anticoagulation with vitamin K antagonists (VKA) and antiaggregant therapy (AAT) are common among dialysis patients, but it is not known if they increase the risk of hemorrhagic (HE) or cardiovascular events (CVE) in the early post-transplant weeks. Methods: We conducted a retrospective analysis on 911 consecutive kidney transplants (KTxs) in order to analyze the impact of AAT and VKA on early HE and CVE—which might be related to their withdrawal—and to identify the main risk factors for these complications. Results: We observed 21/911 HE (2.3 %; 1 death, 4 allograft loss); risk factors for HE at multivariate analysis were: KTx before 2004 (when anti-factor Xa activity measurement was not available; odds ratio, OR 5.835, [95 % confidence interval, 1.241–27.436], p = 0.026), and VKA (OR 7.090 [2.030–24.772], p = 0.002), while AAT was not a risk factor. CVE were 32/911 (3.5 %; 3 deaths, 11 allograft loss): risk factors for CVE at multivariate analysis were: previous cardiovascular events (OR 4.180 [1.615–10.948], p = 0.0032) and cinacalcet use (OR 7.930 [3.002–20.945], p < 0.0001), while neither VKA nor AAT had any impact. Conclusions: In conclusion, HE and CVE are relatively rare but can be severe, but there are no pre-KTx modifiable risk factors. If an anticoagulant therapy with low molecular weight heparins has to be started soon after surgery, monitoring of anti-Xa activity is highly recommended.