Chronic kidney disease and anticoagulation-Quick overview and practical guide

Clinicians managing patients with chronic/end-stage renal disease often are challenged when it comes to anticoagulation in this subset. Unfractioned heparin and warfarin have been in use, and most multidisciplinary teams are comfortable with the drug/s either as prophylaxis or for full anticoagulation. Over the past decade, there has been an increase in the use of low-molecular-weight heparin and more recently of direct oral anticoagulants for anticoagulation. However, there is a reluctance to use these drugs for concern of increased bleeding and management of this complication in patients with renal disease. This paper shares a quick overview of coagulation in chronic/end-stage kidney disease and drugs used for anticoagulation, societal recommendations for their use, with clinical case scenarios, and a proposed management algorithm when patients have a bleed while on anticoagulation.