Use of Newer Anticoagulants in Patients With Chronic Kidney Disease

Bob L. Lobo


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

In This Article

Management of Patients With ACS

LMWHs may be used for the management of patients with ACS.[30] Both enoxaparin and dalteparin have marketing approval for the prevention of ischemic complications in patients with unstable angina and non-Q-wave myocardial infarction (MI).[21,23] Tinzaparin has also been investigated for the treatment of patients with ACS.[31] However, in a recent study, patients with non-ST-segment elevation ACS who received tinzaparin had significantly higher rates of recurrent ischemic events than patients who received enoxaparin.[31] Tinzaparin is not currently approved for the management of ACS.

The DTIs bivalirudin (Angiomax, The Medicines Company) and argatroban are FDA approved for use in more limited populations of patients with ACS.[29,32] Bivalirudin, administered intravenously, was initially indicated for use only in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA) but recently received approval for use in patients undergoing percutaneous coronary intervention (PCI).[32] Both bivalirudin and argatroban are also approved for use in patients with or at risk for HIT who are undergoing PCI.[29,32] Bivalirudin, like most newer anticoagulants, is eliminated primarily by renal clearance.[32] Because argatroban is excreted primarily in the feces, presumably through biliary secretion, it may be preferable over bivalirudin in patients with severe renal impairment.[29]

Fondaparinux is not currently approved for the management of patients with ACS. However, data from the OASIS-5 study showed fondaparinux to be at least as effective as enoxaparin for reducing the risk of ischemic complications in patients with unstable angina or non-ST-segment elevation MI (NSTEMI).[33]


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