by Marshaneil Soumi D’ Rozario | 27 JULY 2018
A recent study of the Clinical Journal of the American society of Nephrology (CJASN) suggests that a few anticoagulants used to treat atrial fibrillation can increase the risk of bleeding in CKD patients. Anticoagulants, commonly referred to as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. As a class of medications, anticoagulants are used in therapy for thrombotic disorders. Oral anticoagulants (OACs) are taken by many people as pills, and various intravenous anticoagulant dosage forms are used in hospitals.
Some antiplatelet drugs (eptifibatide, tirofiban) and anticoagulants (enoxaparin, dalteparin, fondaparinux, lepirudin) are excreted by the kidneys. Renal dysfunction causes these drugs to accumulate in the body. Their half-life increases, leading to increased bleeding risk. CKD patients in severe uremic state also have severe platelet dysfunction, resulting in increased bleeding due to thinners.
Dr. Rajasekhara Chakravarthi, Senior Nephrologist, Star Hospitals, said, “CKD patients on dialysis require anticoagulants for adequate dialyser function, so when they are not kept on anticoagulants, clearance of unwanted toxins will be drastically effected. CKD patients rarely develop intracranial bleeding, intraocular haemorrhage, and bleeding in the renal cysts during dialysis due to anticoagulation, so every patient is peculiar and has to be carefully monitored as far as bleeding and coagulation risk is concerned.”
The use of new oral anticoagulants, like dabigatran etexilate (oral thrombin inhibitor), rivaroxaban and apixaban (oral factor Xa inhibitors), has been increasing due to a decrease in bleeding episodes when compared to warfarin. Renal excretion for dabigatran etexilate, rivaroxaban and apixaban are 80%, 65% and 20% respectively. However, these drugs are infrequently used due to their cost and dose reduction in renal failure patients. Additionally, dabigatran etexilate is contradicted in patients with creatinine clearance less than 15ml/ min.
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