Anticoagulation in acute cardiac care in patients with chronic kidney disease.
The number of patients with coexisting chronic kidney disease (CKD) and cardiovascular disease is growing rapidly. Treatment of these patients is challenging, primarily because of a lack of pharmacokinetic and clinical trial data associated with these combined disease entities. In this report, we discuss the cardiovascular disease risk associated with CKD and review the use of anticoagulation for acute cardiovascular disease in patients with CKD. We evaluate the potential role of direct thrombin inhibitors in patients with renal disease who have acute coronary syndromes, with particular focus on the clinical efficacy of bivalirudin. We conclude that direct thrombin inhibitors, including bivalirudin and argatroban, may be promising alternatives to heparin in patients who have renal insufficiency and are therefore at an increased risk for bleeding. In the treatment of patients with advanced renal insufficiency and cardiovascular disease, however, these agents should be used with dose modification to account for altered excretion.
Reddan
Donal
D
Duke Institute of Renal Outcomes Research and Health Policy, Duke University Medical Center, Durham, NC 27710, USA. redda001@mc.duke.edu
Szczech
Lynda A
LA
O'Shea
Susan
S
Califf
Robert M
RM
D000925:Anticoagulants / Q000378:metabolism / Q000627:therapeutic use*; D000991:Antithrombins / Q000378:metabolism / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002908:Chronic Disease; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D024764:Hirudin Therapy; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology; D010446:Peptide Fragments / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D013449:Sulfonamides; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants; D000991:Antithrombins; D006495:Heparin, Low-Molecular-Weight; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C074619:bivalirudin