Direct oral anticoagulants (DOACs) have been shown to be superior to vitamin K antagonists (VKAs) in regards to safety and efficacy in numerous clinical trials and are now the preferred oral anticoagulant by multiple professional societies. However, patients with significant levels of organ dysfunction were excluded from all major clinical trials, leaving the clinical benefit in these subsets uncertain. Patients with chronic kidney disease (CKD) specifically often require anticoagulation for acute or long‐term indications such as venous thromboembolism, atrial fibrillation, or mechanical heart valves. The efficacy and safety of anticoagulation in patients with renal failure is less certain, however, particularly with DOACs which have altered pharmacokinetics in patients with renal failure and limited observational data on their use in this population. In this review, we compile the most up to date data on the DOAC use in patients with CKD. DOAC use in patients with ESRD and advanced CKD is increasing despite the presence of a clear benefit, and with the potential for increased risk of bleeding compared to warfarin. Apixaban has the greatest amount of outcomes research supporting its use over warfarin in this patient population; however, further research on DOAC safety and efficacy in those with advanced CKD is still needed.
6 3.5. The risk score was divided into low-risk [0-4 points, n ¼ 5,272 (52%); NHD ¼ 10.1%] moderate-risk [5-9 points, n ¼ 3663 (36.7%) NHD ¼ 36.7%], and high-risk [10 points, n ¼ 1210 (11.9%) NHD ¼ 66.1%).Conclusions: A novel risk score was highly predictive for NHD after bypass for LEI using only preoperative comorbidities. High-risk patients account for 12% of bypasses but nearly a third of all patients with NHD. This risk score can be used to determine high-risk patients for discharge preoperatively allowing providers to anticipate their need in the preoperative setting or upon immediate presentation to the hospital.
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