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Anticoagulation Therapy in Advanced Chronic Kidney Disease: Balancing Bleeding and Thromboembolic Risk
Ioana Livia Suliman1,2, Liliana-Ana Tuta1,2, Camelia Pana1,2
1Faculty of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania.
International Journal of Molecular Sciences
|March 28, 2026
Summary
In advanced chronic kidney disease (CKD), apixaban showed fewer bleeding events than acenocoumarol. This study highlights apixaban
Area of Science:
- Nephrology and Hematology
- Pharmacology and Therapeutics
Background:
- Advanced chronic kidney disease (CKD) poses a dual risk of bleeding and thromboembolism.
- Patients with advanced CKD experience a higher bleeding burden that worsens with disease progression.
Purpose of the Study:
- To compare the safety and efficacy of apixaban versus acenocoumarol in advanced CKD patients.
- To evaluate anticoagulant-related bleeding and thromboembolic events in pre-dialysis and hemodialysis CKD stages.
Main Methods:
- Retrospective observational study of 84 adults with CKD stages 4-5 on oral anticoagulation.
- Patients stratified by CKD stage and anticoagulant (apixaban vs. acenocoumarol).
- Outcomes included major bleeding, clinically relevant bleeding, overdose, and thromboembolic events.
Main Results:
- Bleeding events were more frequent in CKD stage 5 (66.0%) than stage 4 (44.1%).
- Apixaban use was linked to significantly fewer bleeding events (44.4%) and overdoses (5.6%) compared to acenocoumarol (66.7% and 18.8%, respectively).
- Thromboembolic event rates were similar between apixaban and acenocoumarol groups (13.9% vs. 16.7%).
Conclusions:
- Oral anticoagulation in advanced CKD carries a significant hemorrhagic risk that increases with declining renal function.
- Apixaban offers a superior safety profile over acenocoumarol in advanced CKD without compromising thromboembolic protection.
- Anticoagulation strategies should consider stage-specific factors in advanced CKD, not solely conventional risk scores.
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