A review of the use of direct oral anticoagulant use in orthotopic heart transplantation recipients

- Due to numerous benefits of direct oral anticoagulants (DOACs) over warfarin, use in orthotopic heart transplant (OHT) patients is being explored despite the limited evidence.
- Clinicians must be aware of several important factors when considering using DOACs in this population.
- Limited data suggests dabigatran and edoxaban may have major interactions with cyclosporine and tacrolimus via P-gp inhibition, rendering their coadministration unadvisable.
- Neither rivaroxaban nor apixaban appear to significantly affect cyclosporine or tacrolimus concentrations.
- Finally, consideration of renal function is crucial for safely using DOACs in OHT patients.