Guidelines for the management of anticoagulation in the perioperative kidney and simultaneous kidney-pancreas (SKP) transplant recipient in NHS Lothian
Pre-operative
Reversal of warfarin pre-operatively in patients undergoing cadaveric renal transplant or SPK is standardised and does not need discussion with Haematology. INR should be checked on admission and patient should be managed with IV Vitamin K ± Beriplex according to the intranet protocol: Haematology> Policy Documents> Beriplex Administration, or click here.
Post-operative
Patients should be categorised as being ‘High Risk’ or ‘Low Risk’ of thrombosis based upon the risk factors detailed below and managed accordingly. All high risk patients should have a written referral made to their local Haematology team by their local Nephrology team prior to referral for transplantation, with clear advice regarding thrombotic risk available to the MDT at the time of listing. Advanced planning is particularly important for patients who have been referred from other healthboards.
* As of October 2025, enoxaparin rather than dalteparin is the LMWH anticoagulation preparation on NHS Lothian formulary. Details, including renal dosing, can be found on the intranet here.
Additional Information
- Beriplex is contra-indicated in patients with heparin-induced thrombocytopenia. Haematology discussion is warranted.
- All patients with mechanical valves should be discussed with their named Cardiologist prior to transplantation.
- Switch from treatment dose enxaparin to warfarin / DOAC can be sooner at the discretion of the duty transplant team.
- DOACs are not licensed for use in patients with mechanical heart valves. Apixaban is the DOAC of choice in NHS Lothian.
This guidance was written by Dr Ashley Simpson (Specialist Registrar in Renal Medicine) and reviewed by Dr Lorna Henderson (Consultant Nephrologist), Mr John Terrace (Consultant Transplant Surgeon), Dr Julia Anderson (Consultant Haematologist) and Dr Nick Cruden (Consultant Cardiologist). Published May 2024. Edited by Agata Paczek (Pharmacist) and Dr Paul Phelan in Oct 2025.