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Review
. 2022 Jan 27;19(3):1436.
doi: 10.3390/ijerph19031436.

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

Sylwester Rogula  1 , Aleksandra Gąsecka  1 , Tomasz Mazurek  1 , Eliano Pio Navarese  2 , Łukasz Szarpak  3 , Krzysztof J Filipiak  4
Affiliations
Review

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

Sylwester Rogula et al. Int J Environ Res Public Health. .

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: CKD; DOAC; ESRD; anticoagulation; chronic kidney disease; direct oral anticoagulants; end-stage renal disease; hemodialysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hemostasis disorders in chronic kidney disease. Created with BioRender.com.
Figure 2
Figure 2
Disadvantages of treatment with vitamin K antagonists in chronic kidney disease (CKD). Created with BioRender.com.
Figure 3
Figure 3
Pleiotropic effects of direct oral anticoagulants. Created with BioRender.com.
See this image and copyright information in PMC

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