Anticoagulation in patients with impaired renal function and with haemodialysis

Summary

Patients with impaired renal function are exposed to an increased risk for bleeding complications depending on the amount of the anticoagulant eliminated by the kidneys. The elimination of unfractionated heparins, vitamin K antagonists and argatroban is only minimally influenced by a reduced renal function. Low-molecular weight heparins, fondaparinux, danaparoid, hirudins and nonvitamin K antagonist oral anticoagulants (NOAC) cause a variably increased bleeding risk in renal impairment. Dose reductions are recommended for all of these anticoagulants in renal impairment, some are even contraindicated at certain levels of renal impairment. Their benefit over the conventional anticoagulants is preserved if renal dosing is employed. For end-stage renal disease patients specific treatment regimens are required.

Zusammenfassung

Patienten mit einer eingeschränkten Nierenfunktion sind einem erhöhten Blutungsrisiko durch Antikoagulanzien ausgesetzt, das von der Nierenausscheidung des Antikoagulanz abhängt. Die Elimination von unfraktioniertem Heparin, Vitamin-K-Antagonisten und Argatroban wird nur geringfügig von der Nierenfunktion beeinflusst. Niedermolekulare Heparine, Fondaparinux, Danaparoid, Hirudin und Nicht-Vitamin-K-Antagonist orale Antikoagulanzien (NOAK) sind mit einem erhöhten Blutungsrisiko bei abnehmender Nierenfunktion verbunden. Dosisreduktionen sind für alle diese Antikoagulanzien erforderlich in Abhängigkeit von der Nierenfunktion, einige sind bei schwerer Nierenfunktionstörung sogar kontraindiziert. Der Benefit gegenüber konventionellen Antikoagulanzien bleibt bei renaler Dosisanpassung bestehen. Für Hämodialysepatienten liegen spezifische Behandlungsregime vor.

Keywords

Heparin - low-molecular weight heparin - direct thrombin inhibitors - oral direct factor Xa inhibitors - vitamin K antagonist - renal impairment

Schlüsselwörter

Heparin - niedermolekulares Heparin - direkte Thrombininhibitoren - orale direkte Faktor-XaInhibitoren - Vitamin-K-Antagonist - Nierenfunktion

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