Anticoagulation in end-stage renal disease

Area of Science:

• Nephrology
• Cardiology
• Hematology

Background:

• Patients with end-stage renal disease (ESRD) exhibit a dual risk of thromboembolism and bleeding.
• Managing anticoagulation in ESRD presents unique clinical challenges due to altered drug pharmacokinetics and increased hemorrhagic risk.

Purpose of the Study:

• To review current evidence on anticoagulation strategies for ESRD patients.
• To focus on stroke prevention in atrial fibrillation and venous thromboembolic disease management.
• To provide practical guidance for clinical decision-making in this complex population.

Main Methods:

• Systematic review of recent evidence regarding anticoagulation in ESRD.
• Analysis of stroke risk in atrial fibrillation and venous thromboembolism treatment.
• Evaluation of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs).

Main Results:

• DOACs require dose adjustments in ESRD due to renal elimination.
• VKAs are not definitively superior to DOACs and may carry a higher bleeding risk.
• Anticoagulation avoidance may be prudent for stroke prevention in many ESRD patients due to high bleeding risk.

Conclusions:

• Anticoagulation in ESRD necessitates careful consideration of bleeding versus clotting risks.
• Current evidence suggests caution with VKAs and highlights the need for individualized DOAC dosing.
• Larger randomized trials are essential to optimize anticoagulation management in ESRD patients for both stroke prevention and VTE treatment.