LAUSR

Introduction Endomyocardial biopsy (EMB) is routinely performed for surveillance of allograft rejection following heart transplantation (HTx). HTx recipients who are on anticoagulation are at higher risk for complications such as bleeding at access site, pericardial effusion, and cardiac tamponade. The safety of apixaban for periprocedural anticoagulation in heart transplant recipients undergoing EMB is not well characterized. Methods This is a retrospective cohort study of all EMBs performed within one year from transplant of 102 HTx recipients from 2016 to 2019. Patients on apixaban were compared to patients not on anticoagulation at the time of EMB. Apixaban was held two days prior to EMB and restarted the evening after EMB if there were no bleeding events. The primary endpoint was major bleeding, defined as life threatening bleeding resulting in death or cardiac tamponade or ≥3 g/dl hemoglobin drop and/or ≥2 units packed red blood cell transfusion. Secondary endpoints included minor bleeding events and thromboembolic events. Results Of the 1189 EMB performed, 474 EMBs occurred with patients taking apixaban while 715 EMBs occurred without anticoagulation. Baseline demographics were similar between groups, though there were more cases utilizing internal jugular vein for the non-anticoagulated group (80% vs 91%, p 0.99). Additionally, the rates of minor bleeding and thromboembolic events were not significant between the two groups. Conclusion Periprocedural anticoagulation with apixaban for patients undergoing EMB following HTx is relatively safe, with very low risk of major or minor bleeding events as well as thromboembolism.