Anticoagulation in renal failure

The prevalence and incidence of chronic kidney disease has increased continuously in Europe and the USA over the last decades. Renal failure also is one of the main complications in critically ill patients. The high frequency of chronic kidney disease, the high cardiovascular comorbidity and the use of extracorporal renal replacement therapies increase the need for anticoagulation tailored to the needs of the individual patient and to the special clinical circumstances. Unfractionated heparins (UFH) and their derivates, the low molecular weight heparins (LMH) and heparinoids, are among the most frequently used parenteral anticoagulants. New direct thrombin inhibitors (DTI) with different pharmacokinetics are appearing, offering interesting options as alternative anticoagulants. This article reviews the pharmacology and the clinical applications of the most common parenteral anticoagulants with a focus on renal failure. © 2007 Springer-Verlag.