{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:50:02Z","timestamp":1791528602678,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>The use of apixaban prior to kidney transplantation is on the rise. However, optimal perioperative management remains uncertain, particularly regarding the need for preoperative reversal with four\u2010factor prothrombin complex concentrate (4F\u2010PCC). Prior reports suggest clinically relevant bleeding without reversal, but potential thrombotic consequences of prophylactic 4F\u2010PCC warrant caution. We hypothesized that withholding preoperative 4F\u2010PCC in patients taking apixaban before kidney transplantation would not increase early postoperative surgical\u2010bed bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, two\u2010center study included adult kidney transplant recipients (KTRs) from January 2019 to September 2025 who had taken apixaban within 48\u2009h before surgery. Patients were stratified by receipt versus nonreceipt of preoperative 4F\u2010PCC. The primary endpoint was surgical\u2010bed bleeding within 3\u2009days of transplant. A one\u2010sided noninferiority test (margin of 15%) was used for the primary endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty KTRs were included, and 14 (28%) received preoperative 4f\u2010PCC and 36 (72%) did not. The median time since the last known apixaban dose was 21\u2009h (interquartile range [IQR], 16\u201324\u2009h) before transplant. Surgical\u2010bed bleeding occurred in 7.1% in the preoperative 4F\u2010PCC cohort and in 5.6% of the no preoperative 4F\u2010PCC cohort (differences, 1.6%; upper one\u2010sided confidence interval [CI], 21.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.11), suggesting similar event rates but not confirming noninferiority. No significant differences were observed between groups in transfusion requirements, delayed graft function, kidney function, venous thromboembolism (1 in the reversal group; 0 in the non\u2010reversal group), or reoperation. Two deaths occurred in the reversal group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Withholding preoperative 4F\u2010PCC in apixaban\u2010treated KTR appears safe, with surgical\u2010bed bleeding rates comparable to those in patients who received preoperative 4F\u2010PCC. Findings support individualized rather than routine preoperative reversal strategies to balance bleeding and thrombotic risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70200","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T03:12:13Z","timestamp":1789441933000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Apixaban Use Before Kidney Transplantation: Is Reversal Necessary?"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-4649","authenticated-orcid":false,"given":"Laura","family":"Cotiguala","sequence":"first","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6328-7483","authenticated-orcid":false,"given":"Anne","family":"Przybylski","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance","family":"Linberger","sequence":"additional","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2149-6520","authenticated-orcid":false,"given":"Marissa","family":"Brokhof","sequence":"additional","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9274-1481","authenticated-orcid":false,"given":"Nicole","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0468-8271","authenticated-orcid":false,"given":"Cara","family":"Joyce","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center  Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3914-4508","authenticated-orcid":false,"given":"Michelle","family":"Dierker","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6542-518X","authenticated-orcid":false,"given":"Megan A.","family":"Rech","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare Edward Hines, Jr. VA Hospital  Hines Illinois USA"},{"name":"Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado Anschutz Medical Campus  Aurora Colorado 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