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

Sylwester Rogula, Aleksandra Gąsecka, Tomasz Mazurek, Eliano Pio Navarese, Łukasz Szarpak and Krzysztof J. Filipiak
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Sylwester Rogula: Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Aleksandra Gąsecka: Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Tomasz Mazurek: Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Eliano Pio Navarese: Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
Łukasz Szarpak: Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
Krzysztof J. Filipiak: Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland

IJERPH, 2022, vol. 19, issue 3, 1-12

Abstract: The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage.

Keywords: direct oral anticoagulants; chronic kidney disease; end-stage renal disease; anticoagulation; hemodialysis; DOAC; CKD; ESRD (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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