Oral Anticoagulant Therapy in Patients Receiving Haemodialysis: Is It Time to Abandon It?

Abstract

Oral anticoagulant (OAC) therapy in haemodialysis patients causes a great deal of controversy. This is because a number of pro- and anticoagulant factors play an important role in end-stage renal failure due to the nature of the disease itself. In these conditions, the pharmacokinetic and pharmacodynamic properties of the OACs used change as well. In the case of the treatment of venous thromboembolism, the only remaining option is OAC treatment according to regimens used for the general population. Prevention of HD vascular access thrombosis with the use of OACs is not very effective and can be dangerous. However, OAC treatment in patients with atrial fibrillation in dialysis population may be associated with an increase in the incidence of stroke and mortality. Doubts should be dispelled by prospective, randomised studies; at the moment, there is no justification for routine use of OACs in the above-mentioned indications. In selected cases of OAC therapy in this group of patients, it is absolutely necessary to control and monitor the applied treatment thoroughly. Indications for the use of OACs in patients with end-stage renal disease, including haemodialysis patients, should be currently limited.

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience

“…Their results, however, proved to not be very encouraging in patients receiving HD, was found to be only slightly more effective in the prevention of thrombotic complications in comparison with the control group, in which oral anticoagulants treatment was not initiated. The results of the above studies and the opinions of experts in the area do not allow a routine use of oral anticoagulants due to the discussed indications . But, some medications possess potentially beneficial effects on AVF patency, among which is antiplatelet therapy.…”

“…The results of the above studies and the opinions of experts in the area do not allow a routine use of oral anticoagulants due to the discussed indications. 26,27 But, some medications possess potentially beneficial effects on AVF patency, among which is antiplatelet therapy. This provides protective endothelial advantages, primarily in the arterial system.…”

A retrospective study of antithrombotic therapy use in an outpatient haemodialysis unit

“…19 Therapeutic anticoagulation is the cornerstone of VTE management in patients, 31,32 and warfarin monotherapy was primarily indicated for VTE in our HD cohort. Other reports specify that chronic anticoagulant use in patients receiving HD should be limited to those with mechanical valves, antiphospholipid syndrome, secondary prevention of severe thromboembolic events, AF or those who have a high risk for stroke, 33,34 all of which were reflected in our study.…”

Comparison of Sampling Methods for International Normalized Ratio Monitoring in Haemodialysis Patients (INRHaemo Study)

“…A variety of pro- and anticoagulant factors present in kidney failure alters haemostasis in these patients and may explain the higher risk of stroke with atrial fibrillation and a higher prevalence of venous thromboembolism in kidney failure compared to the general population [1]. However, the benefits of warfarin use in patients undergoing haemodialysis (HD) remain controversial.…”