Anticoagulation and Renal Insufficiency.

Abstract. In patients with chronic renal disease vitamin K antagonists are a valid anticoagulant treatment with vigilant monitoring of international normalized ratio and bleeding risk assessment. Direct oral anticoagulants are contraindicated in stage 5 chronic kidney disease. Some studies have proposed empirical dose adjustments according to level of renal impairment. In stage 4 chronic kidney disease (CrCl 15 – 30 ml/min) a lower dose of rivaroxaban (15 mg) and edoxaban (30 mg) is proposed, but data are limited. In patients with worsening renal function and treated with rivaroxaban studies have shown lower rates of stroke and systemic embolism, without significant difference in major or non-major clinically relevant bleeding events, compared to patients treated with warfarin. Concerning injectable agents, unfractionated heparin is the anticoagulant of choice in patients with severe renal impairment, but some low-molecular-weight heparins can also be used with appropriate monitoring and subsequent dose a...