Anticoagulant and antiplatelet therapy in patients with chronic kidney disease

Harmon, John Paul; Zimmerman, Danielle; Zimmerman, Deborah

doi:10.1097/mnh.0b013e328365adca

Cited by 13 publications

(11 citation statements)

References 38 publications

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“…157,158 RCTs have yet to assess the benefits and harms of aspirin for stroke prevention in people with advanced CKD and atrial fibrillation, although RCTs have been recommended. 159,160 Warfarin has long been the standard of care for most individuals (general population) with atrial fibrillation.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

2016

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Abstract-Patients with chronic kidney disease and end-stage renal disease are at 5-to 10-fold higher risk for developing cardiovascular disease (CVD) than age-matched controls. Clinically, CVD in this population manifests as coronary artery disease, arrhythmias, stroke, or congestive heart failure. Beyond the traditional risk factors (eg, diabetes mellitus and hypertension), uremia-specific factors that arise from accumulating toxins also contribute to the pathogenesis of CVD.In this review, we summarize the literature on the epidemiology of both traditional and uremia-related CVD and focus on postulated mechanisms of the latter. P. Jousset, MD, 1 describing common causes of death among patients with Bright disease C hronic kidney disease (CKD) is an increasingly urgent public health concern that is projected to grow worldwide at a rate of 8% annually, with the fastest growth expected in developing nations.2,3 It has long been known that patients with kidney failure are predisposed to cardiovascular disease (CVD) that manifests clinically in various forms, including coronary artery disease, atrial or ventricular arrhythmias, myocardial infarction, stroke, or congestive heart failure. Over the last 30 years, it has become clear that the risk of CVD increases early in the course of progressive kidney disease and that the epidemiology, pathophysiology, prevention, and treatment of CVD and CKD are closely related and interdependent. 4 In this review, we initially describe the epidemiology of CVD among people with CKD, noting the limitations of available research. We then discuss common risk factors for CVD (traditional and nontraditional) and key shared aspects of its pathophysiology with CKD. Next we describe emerging diagnostic tools and novel therapies that may help to delay or prevent end-stage renal disease (ESRD) and to curtail the escalating burden of cardiorenal disease. In the final section, we discuss the health services and health policy challenges that CKD and its inextricably linked CVD morbidities pose worldwide, particularly for low-and middle-income countries (LMICs). Phenotypes and Epidemiology of CVD in Patients With CKDPatients with CKD and some forms of CVD share a number of risk factors and underlying pathophysiological mechanisms that, by virtue of their similarities, offer opportunities to improve their management. The epidemiology of 4 of the commonest clinical phenotypes of CVD associated with CKD is discussed below. Coronary Artery DiseaseCoronary artery disease (CAD) is a leading cause of death among people with advanced CKD. Clinical syndromes compatible with CAD (including angina and myocardial infarction) are exceedingly common in patients with nondialysis-dependent CKD, and the incidence of myocardial

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Section: Atrial Fibrillationmentioning

confidence: 99%

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

2016

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“…LMWH at half the therapeutic dose (1 mg/kg once a day) has been used in ESRD patients but can result in major bleeding. 101,102 Although apixaban has a manufacturerrecommended ESRD dosing, long-term data regarding the safety are lacking at this time. Edoxaban 15 mg once a day has been studied in a small group of ESRD patients on hemodialysis, which was well tolerated with minimal dialysis clearance of the drug.…”

Section: Advanced Renal Failurementioning

confidence: 99%

Practical Approach to VTE Management in Hospitalized Patients

Reddy

Dupree

2017

American Journal of Therapeutics

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Venous thromboembolism (VTE) is a commonly feared life-threatening complication in hospitalized patients. Physicians are frequently consulted to diagnose and manage VTE in obstetrics, neurology, and surgical services. VTE should be treated irrespective of the presentation (incidental or symptomatic), etiology (provoked vs. unprovoked), and location of the venous thrombosis (extremities, abdomen, or cerebral). In patients with high clinical suspicion for VTE, physicians are encouraged to empirically start anticoagulant therapy while awaiting diagnostic testing. Thrombolytic therapy is underused by physicians, which is proven to improve the mortality in hypotensive patients with pulmonary embolism. Retrievable inferior vena cava filters have an important role in the prophylaxis and management of selective groups of VTE patients. Physicians should not hesitate to place retrievable inferior vena cava filters when clinically indicated but also should make every effort to remove them when no longer needed. This article extensively reviews various diagnostic and management options based on several clinical situations.

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“…Fifth, vitamin K antagonists have many well-known limitations (i.e., narrow therapeutic window, multiple interactions with food and other drugs, a highly variable metabolism and slow onset and ending of action). Sixth, it is more difficult to maintain INR values within therapeutic targets in patients with CKD: warfarin can cause structural renal damage, deteriorate renal function (warfarinrelated nephropathy) and may promote vascular calcification [34,[77][78][79][80][81][82][83][101][102][103]. Nonvitamin K oral anticoagulants overcome the limitations of vitamin K antagonists.…”

Section: Conclusion and Future Perspectivementioning

confidence: 99%

“…It is also associated with platelet dysfunction leading to increased bleeding, especially in advanced CKD. The underlying reasons for the coexistence of these conflicting hemostatic disorders are poorly understood, with the result that administering anticoagulant treatment to patients with kidney disease is complicated (Box 2) [2,[34][35][36][37][38][39]. Data from the Rotterdam Study showed that after a mean follow-up of 10.2 years, the risk of hemorrhagic stroke increased considerably as GFR decreased [40].…”

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confidence: 99%

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Atrial fibrillation and chronic kidney disease: focus on rivaroxaban

Barrios

Górriz

2015

J. Comp. Eff. Res.

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Renal insufficiency increases the risk of stroke and bleeding in atrial fibrillation patients. Although vitamin K antagonists reduce the risk of stroke in patients with moderate renal dysfunction, this observation is less clear in patients with renal impairment. Moreover, the risk of bleeding with vitamin K antagonists increases as renal function worsens. Maintaining international normalized ratio values within therapeutic targets is more difficult in patients with renal dysfunction, and those agents may cause warfarin-related nephropathy and vascular calcification. Rivaroxaban is the only nonvitamin K oral anticoagulant with a dose specifically tested in patients with moderate renal insufficiency. Rivaroxaban is effective for the prevention of stroke in atrial fibrillation patients with moderate renal dysfunction, with a lower risk of intracranial and fatal bleeding.

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Anticoagulant and antiplatelet therapy in patients with chronic kidney disease

Cited by 13 publications

References 38 publications

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Practical Approach to VTE Management in Hospitalized Patients

Atrial fibrillation and chronic kidney disease: focus on rivaroxaban

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