Key result
Direct oral anticoagulants demonstrate comparable efficacy and potentially greater safety than vitamin K antagonists for treating venous thromboembolism in patients with mild to moderate chronic kidney disease.
Why the study?
Do direct oral anticoagulants improve safety and efficacy compared to vitamin K antagonists in patients with chronic kidney disease and venous thromboembolism?
Do direct oral anticoagulants improve safety and efficacy compared to vitamin K antagonists in patients with chronic kidney disease and venous thromboembolism?
DOACs are a preferred and safe alternative to VKAs for VTE treatment in mild-to-moderate CKD, with emerging evidence supporting apixaban use in severe CKD.
The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate 30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.
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Джиоева et al. (2022) conducted a review in Chronic kidney disease and venous thromboembolic complications. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) and unfractionated heparin was evaluated. Direct oral anticoagulants demonstrate comparable efficacy and potentially greater safety than vitamin K antagonists for treating venous thromboembolism in patients with mild to moderate chronic kidney disease.
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