Anticoagulation in chronic kidney disease: current status and future perspectives

J Thromb Haemost. 2024 Feb;22(2):323-336. doi: 10.1016/j.jtha.2023.09.020. Epub 2023 Sep 29.

Abstract

Chronic kidney disease (CKD) is being diagnosed increasingly worldwide. It is often identified in individuals with comorbidities, which may increase the already heightened risk of thrombosis and hemorrhage associated with CKD. Oral anticoagulation is an effective means of reducing rates of ischemic stroke and systemic embolism in patients with atrial fibrillation and minimizes the morbidity and mortality caused by venous thromboembolic disease. Despite the proven benefits in the majority of patients, these have not been so clearly realized in patients with CKD due to the precarious balance between bleeding and thromboembolic complications. In this review, the current status of anticoagulant utilization in CKD is examined, and some practical recommendations are put forward to assist in the decision-making process of safely anticoagulating patients with CKD diagnosed with atrial fibrillation and venous thromboembolism.

Keywords: AF; VTE; anticoagulation; dialysis; renal impairment.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / adverse effects
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / drug therapy
  • Hemorrhage / drug therapy
  • Humans
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / drug therapy
  • Stroke* / drug therapy
  • Venous Thromboembolism* / complications
  • Venous Thromboembolism* / diagnosis
  • Venous Thromboembolism* / drug therapy

Substances

  • Anticoagulants