American Journal of Cardiovascular Drugs

, Volume 5, Issue 5, pp 291–305

Anticoagulant Use in Patients with Chronic Renal Impairment

  • Anne Grand’Maison
  • Andre F. Charest
  • William H. Geerts
Review Article

DOI: 10.2165/00129784-200505050-00002

Cite this article as:
Grand’Maison, A., Charest, A.F. & Geerts, W.H. Am J Cardiovasc Drugs (2005) 5: 291. doi:10.2165/00129784-200505050-00002


Patients with renal failure have an increased risk of both thrombotic and bleeding complications. A number of antithrombotic drugs undergo renal clearance. Therefore, estimation of renal function is necessary when prescribing these drugs to patients with renal dysfunction. Pharmacokinetic and clinical data in patients with chronic renal impairment are limited for several anticoagulants, and adequate administration information is often absent. Dose adjustment of anticoagulants may be indicated when the creatinine clearance falls below 30 mL/ min. Unfractionated heparin, argatroban, and vitamin K antagonists generally do not require dose adjustment with renal dysfunction. However, smaller doses of warfarin may be required to achieve a particular target international normalized ratio. Close monitoring of anticoagulation is recommended when argatroban or high doses of unfractionated heparin are administered in patients with severe chronic renal impairment. Low-molecular weight heparins, danaparoid sodium, hirudins, and bivalirudin all undergo renal clearance. Lower doses and closer anticoagulation monitoring may be advisable when these agents are used in patients with chronic renal failure. We recommend that fondaparinux sodium and ximelagatran (not yet licensed) be avoided in the presence of severe renal impairment and be used with caution in patients with moderate renal dysfunction. While acknowledging the lack of pharmacokinetic data, this review provides specific recommendations for the use of anticoagulants in patients with chronic renal impairment.

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Anne Grand’Maison
    • 1
  • Andre F. Charest
    • 2
  • William H. Geerts
    • 3
  1. 1.The Department of Medicine, Hematology and Thrombosis ProgramUniversity Health Network, Toronto General Site, University of TorontoTorontoCanada
  2. 2.The Department of Medicine, NephrologySt Michael’s Hospital, University of TorontoTorontoCanada
  3. 3.The Department of Medicine, Thrombosis ProgramSunnybrook and Women’s College Health Sciences Centre, University of TorontoTorontoCanada

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