title: Anticoagulation Therapy in Patients with Chronic Kidney Disease.
abstract: Patients with chronic kidney disease (CKD) are at increased risk for both thrombotic events and bleeding. The early stages of CKD are mainly associated with prothrombotic tendency, whereas in its more advanced stages, beside the prothrombotic state, platelets can become dysfunctional due to uremic-related toxin exposure leading to an increased bleeding tendency. Patients with CKD usually require anticoagulation therapy for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of anticoagulant-induced bleeding. Treatment of patients with CKD should be based on evidence from randomized clinical trials, but usually CKD patients are excluded from these trials. In the past, unfractionated heparins were the anticoagulant of choice for patients with CKD because of its independence of kidney elimination. However, currently low-molecular-weight heparins have largely replaced the use of unfractionated heparins owing to fewer incidences of heparin-induced thrombocytopenia and bleeding. We undertook this review in order to explain the practical considerations for the management of anticoagulation in these high risk population.
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia. dr.fatemeh.askari@gmail.com.|, Dubai, 29005, United Arab Emirates. dr.fatemeh.askari@gmail.com.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Saheb Sharif-Askari
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Syed Azhar
authors.initials: SA
authors.lastname: Syed Sulaiman
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Narjes
authors.initials: N
authors.lastname: Saheb Sharif-Askari
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000991:Antithrombins / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D004334:Drug Administration Schedule; D015951:Factor Xa / Q000378:metabolism; D000077425:Fondaparinux; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D011134:Polysaccharides / Q000008:administration & dosage / Q000493:pharmacokinetics*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D013917:Thrombin / Q000037:antagonists & inhibitors / Q000378:metabolism; D013921:Thrombocytopenia / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D006493:Heparin; D013917:Thrombin; D015951:Factor Xa; D000077425:Fondaparinux
keywords: Anticoagulation; Bleeding; Chronic kidney disease; Enoxaparin; Heparin; Oral anticoagulants; Platelets; Thrombosis