Document Detail

Use of newer anticoagulants in patients with chronic kidney disease.
MedLine Citation:
PMID:  17893411     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The current indications, dosing, and practical considerations for use of newer anticoagulants in patients with various degrees of renal impairment who do not require dialysis are reviewed. SUMMARY: Kidney function should generally be evaluated in all patients commencing anticoagulant therapy. As in the general population, hospitalized patients with impaired renal function most often have impairment that is mild to moderate in severity. Drug dosing in patients with chronic kidney disease may require that adjustment be made to the usual loading or maintenance dose of a drug. Newer anticoagulants with labeling approved by the Food and Drug Administration for venous thromboembolism (VTE) prophylaxis, treatment, or both include the low-molecular-weight heparins (LMWHs) and the factor Xa inhibitor fondaparinux. Some LMWHs are also indicated for the management of patients with acute coronary syndrome (ACS). All of the newer anticoagulants currently available for the management of VTE and ACS have approved labeling for use in patients with mild-to-moderate renal impairment. Currently available LMWHs, factor Xa inhibitors, and direct thrombin inhibitors (excluding argatroban) are eliminated primarily by the kidneys, so dosing in patients with severe renal impairment may require cautious dosage reduction or increased monitoring for bleeding and thromboembolic complications or both. Unfractionated heparin is the preferred anticoagulant for use in most of these patients. CONCLUSION: Newer anticoagulants should be used with caution in patients with mild-to-moderate renal impairment. Unfractionated heparin remains the preferred anticoagulant in most patients with severe renal impairment even though its use is associated with increased bleeding in this population. Dosing of newer anticoagulants, except argatroban, requires cautious dosage reduction and increased monitoring for complications.
Bob L Lobo
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  64     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-25     Completed Date:  2008-01-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2017-26     Citation Subset:  IM    
Clinical Pharmacy, Methodist University Hospital, Memphis, TN 38104, USA.
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MeSH Terms
Acute Coronary Syndrome / drug therapy,  etiology
Anticoagulants / administration & dosage*,  adverse effects*
Drug Labeling
Kidney Failure, Chronic / complications*
Kidney Function Tests
United States
United States Food and Drug Administration
Venous Thrombosis / drug therapy,  etiology
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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