Cargando…

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

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 administe...

Descripción completa

Detalles Bibliográficos
Autores principales: Rogula, Sylwester, Gąsecka, Aleksandra, Mazurek, Tomasz, Navarese, Eliano Pio, Szarpak, Łukasz, Filipiak, Krzysztof J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835601/
https://www.ncbi.nlm.nih.gov/pubmed/35162472
http://dx.doi.org/10.3390/ijerph19031436
_version_ 1784649473876557824
author Rogula, Sylwester
Gąsecka, Aleksandra
Mazurek, Tomasz
Navarese, Eliano Pio
Szarpak, Łukasz
Filipiak, Krzysztof J.
author_facet Rogula, Sylwester
Gąsecka, Aleksandra
Mazurek, Tomasz
Navarese, Eliano Pio
Szarpak, Łukasz
Filipiak, Krzysztof J.
author_sort Rogula, Sylwester
collection PubMed
description 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.
format Online
Article
Text
id pubmed-8835601
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-88356012022-02-12 Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease Rogula, Sylwester Gąsecka, Aleksandra Mazurek, Tomasz Navarese, Eliano Pio Szarpak, Łukasz Filipiak, Krzysztof J. Int J Environ Res Public Health Review 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. MDPI 2022-01-27 /pmc/articles/PMC8835601/ /pubmed/35162472 http://dx.doi.org/10.3390/ijerph19031436 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Rogula, Sylwester
Gąsecka, Aleksandra
Mazurek, Tomasz
Navarese, Eliano Pio
Szarpak, Łukasz
Filipiak, Krzysztof J.
Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title_full Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title_fullStr Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title_full_unstemmed Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title_short Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease
title_sort safety and efficacy of doacs in patients with advanced and end-stage renal disease
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835601/
https://www.ncbi.nlm.nih.gov/pubmed/35162472
http://dx.doi.org/10.3390/ijerph19031436
work_keys_str_mv AT rogulasylwester safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease
AT gaseckaaleksandra safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease
AT mazurektomasz safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease
AT navareseelianopio safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease
AT szarpakłukasz safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease
AT filipiakkrzysztofj safetyandefficacyofdoacsinpatientswithadvancedandendstagerenaldisease