Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Chronic kidney disease (CKD) prevalence is rising globally due to aging populations and increased risk factors like hypertension and obesity.
• Impaired renal function in CKD patients elevates risks for both bleeding and thrombotic events.
• Anticoagulation is crucial for CKD patients at risk of thromboembolic events, with Vitamin K Antagonists (VKAs) and Direct Oral Anticoagulants (DOACs) as primary options.

Purpose of the Study:

• To review current data on the efficacy and safety of DOACs in patients with CKD.
• To provide guidance on selecting optimal DOACs and dosages based on CKD stage.
• To compare DOACs with VKAs in the context of CKD management.

Main Methods:

• Systematic review of existing literature and clinical trial data.
• Analysis of efficacy and safety profiles of various DOACs in CKD populations.
• Evaluation of studies comparing DOACs to VKAs in CKD patients.

Main Results:

• VKAs present challenges in CKD, including anticoagulation control, vascular calcification, and CKD progression.
• DOACs demonstrate comparable efficacy and safety to VKAs in preliminary studies.
• DOACs offer potential benefits such as vascular protection and anti-inflammatory effects.

Conclusions:

• DOACs are increasingly considered for anticoagulation in CKD patients.
• Careful selection of DOACs and appropriate dosage adjustment based on CKD stage is recommended.
• Further research is warranted to fully elucidate the long-term benefits and optimal use of DOACs in diverse CKD populations.