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Comparison of novel oral anticoagulants versus vitamin K antagonists in patients with chronic kidney disease

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Last updated:12th Mar 2020
Published:12th Feb 2020
This review article examines and summarises the differences in clinical findings of the most common anticoagulants when used in patients with chronic kidney disease (CKD). These patients have higher rates of atrial fibrillation and atherothrombotic disease, so are more likely to be prescribed an anticoagulant; in addition they have a higher risk of bleeding complications, making the choice of drug and balancing of preventing thrombosis against excessive bleeding especially difficult.

The authors examined evidence for the efficacy and safety of non-vitamin K oral anticoagulants (NOACs) in patients with moderate CKD and found them similar to vitamin K antagonists such as warfarin in the prevention of stroke and venous thromboembolism. They caution against physicians extrapolating the results of pivotal NOAC clinical trials to their patients who are at risk of adverse events, since many would have been excluded from those trials. The mode of excretion of each NOAC is a key consideration in choice of medication for CKD patients who could benefit from anticoagulant therapy to mitigate risk of thromboembolic events. Considerations for patients on dialysis requiring anticoagulation are also discussed.