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Newer Oral Anticoagulant in Chronic Kidney Disease: What we Should Know

Vijoy Kumar Jha, A Jairam1, D Mahapatra2

  • 1Physician and Nephrologis.

The Journal of the Association of Physicians of India
|December 4, 2019
PubMed

Insights

Newer oral anticoagulants (NOACs) require careful consideration in kidney disease patients. While apixaban shows promise in end-stage renal disease (ESRD), others like dabigatran, rivaroxaban, and edoxaban are not indicated for advanced CKD or ESRD.

Area of Science:

  • Nephrology
  • Pharmacology
  • Cardiology

Background:

  • Oral anticoagulants are crucial for patients with kidney disease and atrial fibrillation.
  • Understanding drug changes with declining glomerular filtration rate (GFR) is essential.
  • CKD and ESRD populations were excluded from major trials of newer oral anticoagulants (NOACs).

Purpose of the Study:

  • To review the clinical pharmacology of NOACs in chronic kidney disease (CKD).
  • To discuss the risks and benefits of NOACs in CKD and end-stage renal disease (ESRD).
  • To explore strategies for reversing NOACs' anticoagulant effects.

Main Methods:

  • Systematic review of clinical pharmacology and trial data.
  • Analysis of renal clearance and bleeding risks associated with NOACs.
  • Evaluation of reversal agents for NOACs.

Main Results:

  • All NOACs have some degree of renal clearance, increasing bleeding risk in renal failure.
  • Apixaban may be as safe or safer than warfarin in ESRD patients.
  • Dabigatran, rivaroxaban, and edoxaban are not indicated for CKD stage 5 or ESRD due to lack of data.

Conclusions:

  • NOAC use in advanced kidney disease requires careful risk-benefit assessment.
  • Apixaban presents a potential option for ESRD patients, pending further data.
  • Specific reversal agents exist for dabigatran and Factor Xa inhibitors, aiding management of bleeding complications.

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