The efficacy and safety of direct oral anticoagulants in patients with chronic renal insufficiency: A review of the literature
| Autor: | Joseph J. Shatzel, Jacob Weber, Ali J. Olyaei |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Population Administration Oral Hemorrhage Kidney Function Tests Risk Assessment Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Renal Insufficiency Chronic education Intensive care medicine Blood Coagulation education.field_of_study business.industry Organ dysfunction Warfarin Anticoagulants Atrial fibrillation Hematology General Medicine medicine.disease United States Europe Clinical trial 030220 oncology & carcinogenesis Kidney Failure Chronic Apixaban Outcomes research medicine.symptom business 030215 immunology Kidney disease medicine.drug |
| Zdroj: | European Journal of Haematology. 102:312-318 |
| ISSN: | 0902-4441 |
| Popis: | Direct oral anticoagulants (DOACs) have been shown to be superior to vitamin K antagonists (VKAs) in regards to safety and efficacy in numerous clinical trials and are now the preferred oral anticoagulant by multiple professional societies. However, patients with significant levels of organ dysfunction were excluded from all major clinical trials, leaving the clinical benefit in these subsets uncertain. Patients with chronic kidney disease (CKD) specifically often require anticoagulation for acute or long-term indications such as venous thromboembolism, atrial fibrillation, or mechanical heart valves. The efficacy and safety of anticoagulation in patients with renal failure is less certain, however, particularly with DOACs which have altered pharmacokinetics in patients with renal failure and limited observational data on their use in this population. In this review, we compile the most up to date data on the DOAC use in patients with CKD. DOAC use in patients with ESRD and advanced CKD is increasing despite the presence of a clear benefit, and with the potential for increased risk of bleeding compared to warfarin. Apixaban has the greatest amount of outcomes research supporting its use over warfarin in this patient population; however, further research on DOAC safety and efficacy in those with advanced CKD is still needed. |
| Databáze: | OpenAIRE |
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