Anticoagulant therapy in renal insufficiency theme: Anticoagulation in complex situations

• Published in: Thrombosis research 2024-09, Vol.241, p.109097, Article 109097
• Main Authors: Parks, Anna L., Stevens, Scott M., Woller, Scott C.
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Anticoagulation; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Cardiovascular disease; Chronic kidney disease; Hemorrhage - chemically induced; Humans; Renal impairment; Renal Insufficiency - complications; Renal Insufficiency - drug therapy; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Venous thromboembolism; Venous Thromboembolism - drug therapy
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2024.109097

Many patients with impaired renal function have concurrent indications for anticoagulant therapy, including atrial fibrillation and venous thromboembolism. For mild chronic kidney disease, data from clinical trials and existing guidelines can be applied to clinical management. The benefits and harms of anticoagulation therapy in patients with more advanced renal impairment are nuanced, as both thrombotic and bleeding risk are increased. Until recently, data regarding anticoagulants in severe renal impairment were primarily observational, but emerging evidence includes a few small clinical trials and the emergence of novel agents hypothesized to have improved efficacy and safety in this population. In this review, we summarize existing data on anticoagulation in patients with chronic kidney disease. We suggest a framework for anticoagulation decision-making in the burgeoning worldwide population of patients with chronic kidney disease. •Chronic kidney disease (CKD) increases thrombosis and bleeding risk.•Existing evidence and guidelines can be applied patients with mild CKD.•Appropriately dosed DOACs are appropriate for mild or moderate CKD.•Data are limited in severe CKD, with ongoing clinical trials.•Severe CKD merits individualized decisions informed by patient preferences.