Clinical pharmacology of oral anticoagulants in patients with kidney disease

Nishank Jain, Robert F. Reilly

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Oral anticoagulants are commonlyuseddrugs inpatients withCKDandpatients with ESKDtotreat atrialfibrillation to reduce stroke and systemic embolism. Some of these drugs are used to treat or prevent deep venous thrombosis and pulmonary embolism in patients with CKD who undergo knee and hip replacement surgeries. Warfarin is the only anticoagulant that is approved for use by the Food and Drug Administration in individuals with mechanical heart valves. Each oral anticoagulant affects the coagulation profile in the laboratory uniquely. Warfarin and apixaban are the only anticoagulants that are Food andDrug Administration approved for use in patientswith CKD and patients with ESKD. However, other oral anticoagulants are commonly used off label in this patient population. Given the acquired risk of bleeding from uremia, these drugs are known to cause increased bleeding events, hospitalization, and overall morbidity. Each anticoagulant has unique pharmacologic properties of which nephrologists need to be aware to optimally manage patients. In addition, nephrologists are increasingly asked to aid in the management of adverse bleeding events related to oral anticoagulant use in patients with CKD and patients with ESKD. This article summarizes the clinicalpharmacology of these drugs andidentifies knowledge gaps in the literature related to their use.

Original languageEnglish (US)
Pages (from-to)278-287
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number2
StatePublished - Feb 7 2019
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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