Medicus, Vol. 33 No. 1 Tromboembolije, 2024.
Review article
Kidney Function and Anticoagulants
Ingrid Prkačin
Abstract
Renal function is crucial for patients using anticoagulants. The incidence of renal function deterioration during anticoagulation therapy and its impact of adverse events is higher in advanced age, lower body weight, congestive heart failure, and increased with the CHADS2 score. Patients treated with anticoagulant medication make up a significant percentage of everyday medicine as well as emergency room services. Their treatment is challenging on the one hand because of the increased risk of bleeding, and on the other, because of the increased risk of thromboembolism due to anticoagulant therapy interruption. Invasive procedures require a multidisciplinary approach and the use of protocols for specific situations. Direct oral anticoagulant drugs (DOACs) achieve their anticoagulant effect by the direct inhibition of thrombin (dabigatran) or by the direct inhibition of activated factor X (rivaroxaban, apixaban and edoxaban). The use of DOACs means a step forward in the quality and safety of the treatment, and the guidelines give them preference over the vitamin K antagonists, which have been first-choice anticoagulants for a long time. Based on the results of randomized studies which compared the effects of certain DOACs and warfarin, it can be concluded that DOACs are superior to warfarin in stroke and systemic embolism prevention. Although DOACs are associated with fewer interactions with other drugs compared to warfarin and heparin, the combination of DOACs and many drugs requires caution and, in some cases, clinical monitoring.
Keywords
kidney function; DOACs; bleeding; emergencies; interactions
Hrčak ID:
321780
URI
Publication date:
24.10.2024.
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