Sailing Between Scylla and Charybdis: Oral Long-term Anticoagulation in Dialysis Patients

Thilo Krüger; Vincent Brandenburg; Georg Schlieper; Nikolaus Marx; Jürgen Floege


Nephrol Dial Transplant. 2013;28(3):534-541. 

In This Article

Risk of Haemorrhage in HD Patients

Patients on haemodialysis (HD) carry a significantly increased bleeding risk.[1,2] Depending on the cohorts investigated, previous data describe a 1.4- to 5.2-fold increase in the relative risk for gastrointestinal bleeding[3,4] and an ~6 –10 times higher incidence of intracerebral bleeding in end-stage renal disease (ESRD) patients compared with non-renal patients.[5,6] The reasons for this increased bleeding risk are multifactorial, in part related to uraemia, such as decreasing platelet aggregation and increasing bleeding time. The latter may be linked to uraemic toxins[7] and impaired nitric oxide metabolism.[8]