Anticoagulation in CKD and ESRD

Abstract

In this review we discuss the evolving literature of anticoagulation in the context of the nephrology patient. Whereas CKD patients with atrial fibrillation, should be anticoagulated, the benefit of anticoagulation for those on dialysis remains controversial due to an increased risk of bleeding. The availability of direct oral anticoagulants offers new options for those with CKD. Until studies are available in stage 4 and 5/dialysis, this class of medication should be used with caution in this population. For anticoagulated patients requiring interventional procedures, a risk-based approach should be employed to determine those who will benefit from bridging anticoagulation. Either unfractionated heparin or low molecular weight heparin are adequate choices for bridging anticoagulation. Unfractionated heparin and renally dosed low molecular weight heparin can be safely used in non-end stage CKD patients with an acute coronary syndrome. Similarly, the use of unfractionated heparin and low molecular weight heparin are comparable for thromboembolic prophylaxis in CKD/dialysis and extracorporeal circuit anticoagulation of the dialysis circuit.

Keywords: Anticoagulation; CKD; Hemodialysis; Heparin; LMWH.