Anticoagulation in CKD

Abstract

There are many indications for anticoagulation in patients with chronic kidney disease (CKD), including stroke reduction in atrial fibrillation, myocardial infarction, prosthetic valve replacement, and prevention and treatment of venous thromboembolism. The risk of stroke in patients with stage 3 CKD and end-stage renal disease (ESRD) is higher than that of the general population and, in combination with atrial fibrillation, necessitates oral anticoagulation. Warfarin is the most commonly used anticoagulant in this population, but warfarin increases the risk of bleeding in CKD patients and may also contribute to vascular calcification for those on dialysis. The direct oral anticoagulants, dabigatran, rivaroxaban, apixaban, and edoxaban have been studied in the general population, but studies do not include patients with severe CKD, or dialysis-dependence, which makes inference of benefit difficult. This chapter explores the available evidence for anticoagulation in CKD and potential bleeding risks.