Use of Newer Anticoagulants in Patients With Chronic Kidney Disease

Bob L. Lobo

Disclosures

Am J Health Syst Pharm. 2007;64(19):2017-2026. 

In This Article

Summary

Most of the newer anticoagulants with FDA-approved labeling for the management of VTE and ACS are primarily eliminated by renal clearance. It is therefore important to consider whether patients have impaired renal function before newer anticoagulants are administered. In clinical practice, the presence of impaired renal function is usually detected with estimated GFRs.

Prescribing information for most of these drugs recommends increased monitoring for bleeding complications and urges caution when used in patients with renal insufficiency. Specific recommendations for dosage adjustment in renal insufficiency are lacking for dalteparin, tinzaparin, and fondaparinux. Dalteparin and tinzaparin may be used cautiously without dosage adjustment, but fondaparinux should be avoided in patients with severe renal impairment. The manufacturer&'s dosing recommendations for lepirudin may lead to excessive anticoagulation in some patients, and more conservative dosing or the use of argatroban in patients with renal impairment may be appropriate. Current enoxaparin dosing recommendations may not be optimal for some patients with moderate or severe renal impairment. It is unclear whether the use of anti-factor Xa monitoring will reduce bleeding or improve efficacy.

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