Anticoagulation in Patients with Advanced Chronic Kidney Disease: Walking the Fine Line between Benefit and Harm

Publication date: Available online 11 July 2019Source: Canadian Journal of CardiologyAuthor(s): Januvi Jegatheswaran, Gregory L. Hundemer, David Massicotte-Azarniouch, Manish M. SoodAbstractChronic kidney disease affects over 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of both thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to guide decision-making in this area further compounds the dilemma. In this review, we will discuss the physiology and epidemiology of bleeding and thrombosis in patients with kidney disease. We will specifically focus on patients with advanced kidney disease (eGFR ≤ 30 ml/min) or on dialysis and focus on the Nephrologists perspective regarding these issues. We will summarize the existing evidence for anticoagulation use in the prevention of stroke with AF and provide practical clinical recommendations when considering anticoagulation use in this population. Lastly we examine specific scenarios such as the use of GFR estimating equation and dosing, the use of existing prediction tools for stroke and hemorrhage risk, current patterns of anticoagulation use (including during the dialysis procedure) and vascular calcification with vitamin K antagonist use in ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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Publication date: Available online 31 March 2020Source: Neurophysiologie CliniqueAuthor(s): Karim Jamal, Stéphanie Leplaideur, Chloé Rousseau, Sébastien Cordillet, Annelise Moulinet Raillon, Simon Butet, Armel Cretual, Isabelle Bonan
Source: Neurophysiologie Clinique - Category: Neuroscience Source Type: research
Authors: Kamimura MA, Nerbass FB PMID: 32227070 [PubMed - as supplied by publisher]
Source: Jornal Brasileiro de Nefrologia - Category: Urology & Nephrology Tags: J Bras Nefrol Source Type: research
Authors: Ventura CG, Roque FL, Sousa IQ, Lobo RD, Luders C Abstract INTRODUCTION: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. METHODS: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospit...
Source: Jornal Brasileiro de Nefrologia - Category: Urology & Nephrology Tags: J Bras Nefrol Source Type: research
Jeffrey A. SingerAs hospital emergency rooms and intensive care units swell with patients infected with the COVID-19 virus, political leaders coordinating responses in “hot spots” are asking doctors and other medical professionals in parts of the country less impacted by the pandemic to come to the rescue. New York Governor Andrew Cuomo issued such a plea the other day. Governors are issuing executive orders that relaxoccupational licensing restrictions on the free movement of health care practitioners. Some are also expanding thescope of practice of various licensed health care professionals, permitting t...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged  ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followe...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusion: In early-stage CKD, NOACs had a benefit-risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs. Primary Funding Source: None. (PROSPERO: CRD42017079709). PMID: 31307056 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Abstract In patients diagnosed with chronic kidney disease (CKD), atrial fibrillation (AF) is associated with an increased risk of thromboembolism and stroke. Moreover, patients with CKD - especially those in end-stage renal disease - also present an increased risk of bleeding. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF and an increased risk of stroke. However, the underuse of these drugs was observed, mainly due to safety reasons and restricted evidence on efficacy. Much evidence suggests that non-vitamin K-dependent oral anticoagulant agents significantly reduce the...
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Authors: Joung B Abstract Regulatory approvals of non-vitamin K antagonist oral anticoagulants (NOACs) have been based on large randomized phase III trials evaluating dabigatran, rivaroxaban, apixaban, or edoxaban relative to warfarin for atrial fibrillation (AF). The results of the trials showed that all NOACs were at least non-inferior to warfarin in the prevention of stroke/thromboembolism and showed lower rates of intracranial bleeding than those associated with warfarin. However, the trials were designed differently, varied in the inclusion/exclusion criteria, and used either one dose or a low/high dose of the...
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
This article is a review of stroke in patients with CKD and approach to managing it.
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
More News: Atrial Fibrillation | Bleeding | Canada Health | Cardiology | Cardiovascular | Chronic Kidney Disease | Dialysis | Epidemiology | Heart | Hemorrhagic Stroke | Physiology | Stroke | Thrombosis | Urology & Nephrology | Vitamin K | Vitamins