title: Anticoagulation in patients with impaired renal function and with haemodialysis. Anticoagulant effects, efficacy, safety, therapeutic options.
abstract: Patients with impaired renal function are exposed to an increased risk for bleeding complications depending on the amount of the anticoagulant eliminated by the kidneys. The elimination of unfractionated heparins, vitamin K antagonists and argatroban is only minimally influenced by a reduced renal function. Low-molecular weight heparins, fondaparinux, danaparoid, hirudins and non-vitamin K antagonist oral anticoagulants (NOAC) cause a variably increased bleeding risk in renal impairment. Dose reductions are recommended for all of these anticoagulants in renal impairment, some are even contraindicated at certain levels of renal impairment. Their benefit over the conventional anticoagulants is preserved if renal dosing is employed. For end-stage renal disease patients specific treatment regimens are required.
authors.affiliation: Job Harenberg, MD, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstr. 14, 68169 Mannheim, Germany, E-mail: job.harenberg@medma.uni-heidelberg.de.
authors.forename: J
authors.initials: J
authors.lastname: Harenberg
authors.forename: V A-T
authors.initials: VA
authors.lastname: Hentschel
authors.forename: S
authors.initials: S
authors.lastname: Du
authors.forename: S
authors.initials: S
authors.lastname: Zolfaghari
authors.forename: R
authors.initials: R
authors.lastname: Krämer
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.forename: B K
authors.initials: BK
authors.lastname: Krämer
authors.forename: M
authors.initials: M
authors.lastname: Wehling
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006487:Hemostasis; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000150:complications / Q000628:therapy*; D018570:Risk Assessment; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Heparin; direct thrombin inhibitors; low-molecular weight heparin; oral direct factor Xa inhibitors; renal impairment; vitamin K antagonist