Anticoagulation in Patients with Chronic Kidney Disease

Am J Nephrol. 2023 Nov 30. doi: 10.1159/000535546. Online ahead of print.ABSTRACTBACKGROUND: Both atrial fibrillation and venous thromboembolic disease (VTE) are highly prevalent among patients with chronic kidney disease (CKD). Until recently, warfarin was the most commonly prescribed oral anticoagulant. Direct oral anticoagulants (DOACs) have important advantages and have been shown to be non-inferior to warfarin with respect to stroke prevention or recurrent VTE in the general population, with lower bleeding rates. This review article will provide available evidence on use of DOACs in patients with CKD.SUMMARY: In post-hoc analyses of major randomized studies with DOACs for stroke prevention in atrial fibrillation, in the subgroup of participants with moderate CKD, defined as a creatinine clearance (CrCl) of 30-50 ml/min, dabigatran 150 mg and apixaban were associated with lower rates of stroke and systemic embolism, whereas apixaban and edoxaban were associated with lower bleeding and mortality rates, compared with warfarin. In retrospective observational studies in patients with advanced CKD (defined as a CrCl <30 ml/min) and atrial fibrillation, DOACs had similar efficacy with warfarin with numerically lower bleeding rates. All agents warrant dose adjustment in moderate to severe CKD. In patients on maintenance dialysis, the VALKYRIE trial which was designed initially to study the effect of vitamin K on vascular calcification progression, established superiority for ...
Source: American Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research