Key result
DOACs match VKAs for efficacy and safety in CKD while potentially offering vascular protection.
Why the study?
Although VKAs are first-line in advanced CKD, treatment is challenging due to monitoring difficulties, vascular calcification, and CKD progression, while preliminary reports suggest DOACs may offer vascular protection and comparable efficacy and safety.
Do DOACs improve efficacy and safety compared to VKAs in patients with advanced and end-stage renal disease?
Do DOACs improve efficacy and safety compared to VKAs in patients with advanced and end-stage renal disease?
DOACs may offer a comparable efficacy and safety profile to VKAs in patients with advanced CKD, while potentially avoiding VKA-associated vascular calcification and CKD progression.
May support DOAC preference in CKD to limit vascular risks; leaves open RCT confirmation in advanced disease.
The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage.
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Rogula et al. (2022) conducted a review in Chronic kidney disease. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Efficacy and safety of treatment. Direct oral anticoagulants demonstrate comparable efficacy and safety to vitamin K antagonists in patients with chronic kidney disease, while potentially offering vascular protection.
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