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Updated: Aug 5, 2026

Direct Drug Delivery to Kidney via the Renal Artery
11:18

Direct Drug Delivery to Kidney via the Renal Artery

Published on: April 17, 2021

How to Safely Anticoagulate Patients With Renal Impairment

Nadir Aziz1,2, Robyn Haysom2,3, Jecko Thachil4,5

  • 1Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.

British Journal of Hospital Medicine (London, England : 2005)
|July 30, 2026
PubMed

Insights

Managing blood clots in chronic kidney disease (CKD) is complex due to bleeding and clotting risks. Direct oral anticoagulants (DOACs) show promise for mild-to-moderate CKD, but more research is needed for severe kidney disease.

Area of Science:

  • Nephrology
  • Hematology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) affects millions globally, increasing risks of both blood clots (thrombosis) and bleeding.
  • CKD complicates anticoagulant therapy due to factors like endothelial dysfunction, inflammation, platelet dysfunction, and vascular abnormalities.

Purpose of the Study:

  • To review anticoagulant options for patients with CKD, focusing on venous thromboembolism (VTE) treatment and atrial fibrillation (AF) prophylaxis.
  • To highlight the current challenges and knowledge gaps in managing anticoagulation in CKD patients, particularly those with severe disease.

Main Methods:

  • Literature review of studies on anticoagulant use in CKD.
  • Analysis of thrombotic and bleeding risks associated with different anticoagulants in CKD populations.
  • Discussion of current guideline recommendations and emerging evidence for direct oral anticoagulants (DOACs).

Main Results:

  • Warfarin and low-molecular-weight heparin are current guideline recommendations for anticoagulation in CKD.
  • Studies suggest DOACs may have a favorable profile in mild-to-moderate CKD, showing reduced thrombotic events and bleeding.
  • Limited data exists on DOAC efficacy and safety in severe CKD and end-stage renal disease (ESRD).

Conclusions:

  • Anticoagulant prescribing in CKD presents a complex balance between thrombotic and bleeding risks.
  • DOACs show potential in mild-to-moderate CKD, but further clinical trials are essential for severe CKD and ESRD populations.
  • More research is urgently needed to establish optimal anticoagulation strategies for all stages of CKD.

Keywords:
CKDESRDanti-Xaanticoagulationhaemorrhage

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