Abstract
Oral anticoagulant (OAC) therapy in haemodialysis patients causes a great deal of controversy. This is because a number of pro- and anticoagulant factors play an important role in end-stage renal failure due to the nature of the disease itself. In these conditions, the pharmacokinetic and pharmacodynamic properties of the OACs used change as well. In the case of the treatment of venous thromboembolism, the only remaining option is OAC treatment according to regimens used for the general population. Prevention of HD vascular access thrombosis with the use of OACs is not very effective and can be dangerous. However, OAC treatment in patients with atrial fibrillation in dialysis population may be associated with an increase in the incidence of stroke and mortality. Doubts should be dispelled by prospective, randomised studies; at the moment, there is no justification for routine use of OACs in the above-mentioned indications. In selected cases of OAC therapy in this group of patients, it is absolutely necessary to control and monitor the applied treatment thoroughly. Indications for the use of OACs in patients with end-stage renal disease, including haemodialysis patients, should be currently limited.
Highlights
Chronic kidney disease (CKD) constitutes an increasingly serious challenge for modern medicine, both in its strictly clinical aspect and in the epidemiological one
Attempts to apply the results of studies carried out in the general population, from which patients with end-stage renal failure are usually excluded to begin with, to patients receiving haemodialysis are unjustified but sometimes have downright negative influence on the effectiveness of treatment and patients’ safety
Oral anticoagulant (OAC) treatment according to its typical indications in patients with end-stage CKD or in those receiving haemodialysis an off-label use? an experimental one? and is it justified? these questions remain open
Summary
Chronic kidney disease (CKD) constitutes an increasingly serious challenge for modern medicine, both in its strictly clinical aspect and in the epidemiological one. Prognoses for the few years suggest a further increase in the number of patients requiring different forms of renal replacement therapy, including patients receiving haemodialysis, especially among patients with diabetes, arterial hypertension as well as the elderly ones [4]. The indications for treatment with oral anticoagulants (OACs) as well as their use have increased significantly [5] This phenomenon included both the entire population of patients with CKD and patients receiving. Attempts to apply the results of studies carried out in the general population, from which patients with end-stage renal failure are usually excluded to begin with, to patients receiving haemodialysis are unjustified but sometimes have downright negative influence on the effectiveness of treatment and patients’ safety
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