Balancing the Benefits and Harms of Oral Anticoagulation in Chronic Kidney Disease: What Does Available Evidence Tell Us?
Authors: Ainslie Hildebrand, Christine Ribic, Deborah Zimmerman
Journal: Annals of Internal Medicine (2019)

Editorials6 August 2019Balancing the Benefits and Harms of Oral Anticoagulation in Chronic Kidney Disease: What Does Available Evidence Tell Us?Ainslie Hildebrand, MD, MSc, Christine Ribic, MD, MSc, and Deborah Zimmerman, MD, MScAinslie Hildebrand, MD, MScUniversity of Alberta, Edmonton, Alberta, Canada (A.H.)Search for more papers by this author, Christine Ribic, MD, MScMcMaster University, Hamilton, Ontario, Canada (C.R.)Search for more papers by this author, and Deborah Zimmerman, MD, MScUniversity of Ottawa, Ottawa, Ontario, Canada (D.Z.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1504 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The risks for venous thromboembolism (VTE) and atrial fibrillation (AF) are 2 to 3 times and 10 to 20 times greater in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), respectively, than in the general population (1, 2). In patients with ESKD, VTE is associated with an increased risk for death and AF is associated with increased risks for stroke and death (1, 2). Older age, hypertension, diabetes mellitus, and congestive heart failure are highly prevalent in patients with CKD and ESKD, such that, on the basis of guidelines developed for the general population, most require VTE ...References1. Molnar AO, Bota SE, McArthur E, et al. Risk and complications of venous thromboembolism in dialysis patients. Nephrol Dial Transplant. 2018;33:874-80. [PMID: 28992258] doi:10.1093/ndt/gfx212 CrossrefMedlineGoogle Scholar2. Reinecke H, Brand E, Mesters R, et al. Dilemmas in the management of atrial fibrillation in chronic kidney disease. J Am Soc Nephrol. 2009;20:705-11. [PMID: 19092127] doi:10.1681/ASN.2007111207 CrossrefMedlineGoogle Scholar3. Andrade JG, Verma A, Mitchell LB, et al; CCS Atrial Fibrillation Guidelines Committee. 2018 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol. 2018;34:1371-92. [PMID: 30404743] doi:10.1016/j.cjca.2018.08.026 CrossrefMedlineGoogle Scholar4. Qaseem A, Chou R, Humphrey LL, et al; Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;155:625-32. [PMID: 22041951]. doi:10.7326/0003-4819-155-9-201111010-00011 LinkGoogle Scholar5. Elliott MJ, Zimmerman D, Holden RM. Warfarin anticoagulation in hemodialysis patients: a systematic review of bleeding rates. Am J Kidney Dis. 2007;50:433-40. [PMID: 17720522] CrossrefMedlineGoogle Scholar6. Nigwekar SU, Kroshinsky D, Nazarian RM, et al. Calciphylaxis: risk factors, diagnosis, and treatment. Am J Kidney Dis. 2015;66:133-46. [PMID: 25960299] doi:10.1053/j.ajkd.2015.01.034 CrossrefMedlineGoogle Scholar7. Wizemann V, Tong L, Satayathum S, et al. Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy. Kidney Int. 2010;77:1098-106. [PMID: 20054291] doi:10.1038/ki.2009.477 CrossrefMedlineGoogle Scholar8. Ha JT, Neuen BL, Cheng LP, et al. Benefits and harms of oral anticoagulant therapy in chronic kidney disease. A systematic review and meta-analysis. Ann Intern Med. 2019;171:181-9. doi:10.7326/M19-0087 LinkGoogle Scholar9. Winkelmayer WC, Liu J, Setoguchi S, et al. Effectiveness and safety of warfarin initiation in older hemodialysis patients with incident atrial fibrillation. Clin J Am Soc Nephrol. 2011;6:2662-8. [PMID: 21959598] doi:10.2215/CJN.04550511 CrossrefMedlineGoogle Scholar10. Siontis KC, Zhang X, Eckard A, et al. Outcomes associated with apixaban use in patients with end-stage kidney disease and atrial fibrillation in the United States. Circulation. 2018;138:1519-29. [PMID: 29954737] doi:10.1161/CIRCULATIONAHA.118.035418 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Alberta, Edmonton, Alberta, Canada (A.H.)McMaster University, Hamilton, Ontario, Canada (C.R.)University of Ottawa, Ottawa, Ontario, Canada (D.Z.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1504.Corresponding Author: Deborah Zimmerman, MD, MSc, University of Ottawa, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9, Canada; e-mail, [email protected]on.ca.Current Author Addresses: Dr. Hildebrand: University of Alberta, 11-112R Clinical Sciences Building, 152 University Campus, Edmonton, Alberta T6G 2G3, Canada.Dr. Ribic: St. Joseph's Hamilton Healthcare, 50 Charlton Avenue East, Marian Wing M311, Hamilton, Ontario L8N 4A6, Canada.Dr. Zimmerman: Ottawa Hospital, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9, Canada.This article was published at Annals.org on 16 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBenefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease Jeffrey T. Ha , Brendon L. Neuen , Lap P. Cheng , Min Jun , Tadashi Toyama , Martin P. Gallagher , Meg J. Jardine , Manish M. Sood , Amit X. Garg , Suetonia C. Palmer , Patrick B. Mark , David C. Wheeler , Vivekanand Jha , Ben Freedman , David W. Johnson , Vlado Perkovic , and Sunil V. Badve Metrics Cited byCardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort 6 August 2019Volume 171, Issue 3Page: 214-215KeywordsAnticoagulant therapyChronic kidney diseaseEnd stage kidney diseaseHemorrhageHemorrhagic strokeMedical dialysisRenal failureStrokeSystematic reviewsThrombosis ePublished: 16 July 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...