Safety of apixaban prior to liver transplantation: A single-center Australian case-control study in a low MELD population.

Patients awaiting liver transplant (LT) are commonly prescribed anticoagulation. Indications include portal vein thrombosis and atrial fibrillation. The safety of continuing apixaban until the time of deceased donor LT is unknown. We assessed the safety of apixaban, administered within 48 hours of LT. A total of 26 patients were treated with apixaban within 48 hours of LT surgery. The median Modelfor End-stage Liver Disease (MELD) score was 18.5 (interquartile range, 16.2-20.0). Using 2:1 propensity-score matching, 52 control patients were identified from a prospectively maintained registry. The coprimary outcome was packed red blood cells and intraoperative cell salvage volume transfused during LT. The median time between the last apixaban dose and surgery start was 18.2 hours. There was no significantly increased intraoperative blood product requirement in patients on apixaban. Packed red blood cells (898 vs 997 mL, P = 1.00) and intraoperative cell salvage volumes (1500 vs 1144 mL, P = .87) were comparable between patients treated with apixaban and controls. Fresh frozen plasma (133 vs 306 mL, P = .16), cryoprecipitate (60 vs 136 mL, P = .11), and platelet volumes (105 vs 302 mL, P = .06) were also comparable. There was no difference in return to theater for early bleeding or in graft or patient survival at 12 months posttransplant. Apixaban appears safe to continue in the peri-LT setting for patients awaiting deceased donor LT in this population with low MELD scores.