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Anticoagulation in Patients with Renal Insufficiency

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Precision Anticoagulation Medicine

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Abstract

The retained metabolic products in kidney insufficiency are toxic to two main cells connected with blood coagulation, namely, the endothelial cells and the blood platelets. These interact with each other, with leukocytes and with a complex metabolic network involving inflammation, complement activation, coagulation, fibrinolysis, and others. Owing to the unstable nature of kidney insufficiency, the associated coagulation disorders vary from a procoagulant state where endothelial cell injury predominates, to a bleeding disorder where platelet dysfunction supervenes. Amid all that, patients with kidney insufficiency may need anticoagulation either for the commonly associated heart disease, venous thrombosis, antiphospholipid syndrome, etc., for the treatment of certain intrinsic renal disease, or for extracorporeal therapy. This requires a careful benefit/risk balance that can be quantitated by validated scores. As the decision to anticoagulate is made, several practical issues emerge, including the choice of pharmacokinetically compatible agents, their dose in relation to the degree of impairment of kidney function, and potential drug-drug interactions. The decision is confounded by the plethora of currently available anticoagulants, often with superior efficacy, less bleeding tendency, and limited need for monitoring and frequent dose tailoring compared to the traditional heparin and warfarin.

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Abbreviations

ABMR:

Antibody-mediated rejection

ADP:

Adenosine diphosphate

ACS:

Acute coronary syndrome

AF:

Atrial fibrillation

CKD:

Chronic kidney disease

DVT:

Deep vein thrombosis

GFR:

Glomerular filtration rate

LMWH:

Low-molecular-weight heparin

NSTEMI:

Non-ST segment elevation myocardial infarction

PAI:

Plasminogen activator inhibitor

PAF:

Platelet-activating factor

PAR:

Protease-activated receptor

PCI:

Percutaneous intervention

PDGF:

Platelet-derived growth factor

PE:

Pulmonary embolism

RAAS:

Renin-angiotensin-aldosterone system

ROS:

Reactive oxygen species

RVT:

Renal vein thrombosis

STEMI:

ST segment elevation myocardial infarction

TMA:

Thrombotic microangiopathy

TNF:

Tumor necrosis factor

tPA:

Tissue plasminogen activator

vWF:

von Willebrand factor

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Authors and Affiliations

  1. The Cairo Kidney Center, Cairo, Egypt

    Rashad S. Barsoum, Hanaa Wanas & Tamer Shehab

  2. Department of Internal Medicine and Nephrology, Kasr-El-Aini Medical School, Cairo University, Cairo, Egypt

    Rashad S. Barsoum

  3. Department of Pharmacology, Kasr-El-Aini Medical School, Cairo University, Cairo, Egypt

    Hanaa Wanas

  4. Department of Nephrology, Sahel Teaching Hospital, Ministry of Health, Cairo, Egypt

    Tamer Shehab

Authors
  1. Rashad S. Barsoum
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  2. Hanaa Wanas
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  3. Tamer Shehab
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Editors and Affiliations

  1. Saskatoon Cancer Centre College of Medicine University of Saskatchewan, Saskatoon, SK, Canada

    Hadi Goubran

  2. Faculty of Medicine Cairo University, Giza, Egypt

    Gaafar Ragab

  3. College of Human Medicine Michigan State University, East Lansing, MI, USA

    Suzy Hassouna

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Barsoum, R.S., Wanas, H., Shehab, T. (2020). Anticoagulation in Patients with Renal Insufficiency. In: Goubran, H., Ragab, G., Hassouna, S. (eds) Precision Anticoagulation Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-25782-8_9

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