Use of antiplatelet therapy and direct oral anticoagulants in candidates for renal transplantation: The French guidelines from the CTAFU

To define guidelines for the use of antiplatelet therapy (AT) and direct oral anticoagulants (DOAC) in candidates for kidney allotransplantation.

A review of the medical literature following a systematic approach was conducted by the CTAFU to report the use of AT and DOAC before major surgery and in the setting of advanced chronic kidney disease, defining their managment prior to kidney transplantation with the corresponding level of evidence.

DOAC are not recommended in patients under dialysis. Aspirin therapy, but not anti-P2Y12 and DOAC, may be maintained during renal transplantation. Anti-P2Y12 and DOAC should not be use in patients awaiting a kidney transplant, except when a living donor is scheduled, therefore authorizing treatment interruption in optimal conditions. Further data regarding DOAC reversion and monitoring may improve their use in this setting. Global level of evidence is weak.

These French recommendations should contribute to improve surgical management of kidney transplant candidates exposed to AT or DOA.

Published by Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie, 2021. The guideline itself is at the source linked here.

doi.org/10.1016/j.purol.2020.03.015