ANTICOAGULANT TREATMENT IN PATIENTS WITH RENAL INSUFFICIENCY

BACKGROUND In the recent years, the number of patients treated with anticoagulant therapy isincreasing. Among them, there is also an increased number of patients with renal insufficiency.Due to changes in coagulation and fibrinolityc system activity these patients are atincreased risk of bleeding and thrombotic complications when treated with anticoagulants.Unfractionated heparin, low-molecular-weight-heparins and vitamin K antagonistare used for anticoagulant therapy in patients with renal insufficiency. Dosing of unfractionatedheparin and vitamin K antagonists in these patients does not differ fromdosing in patients without renal disease. However, special caution should be taken whenusing low molecular weight heparins for therapy or prophylaxis in patients with renalinsufficiency. Low-molecular-weight-heparins are cleared principally by renal route andtheir biological half-life is prolonged in patients with renal insufficiency. If low-molecularweight-heparin is chosen for anticoagulant therapy, monitoring should be performed withanti-factor Xa activity measurements.Clinicians are often required to decide on how to manage patients receiving long-termanticoagulant therapy during and after invasive nephrological procedures. CONCLUSIONS This article summarizes recommendations on use of anticoagulant drugs in patientswith renal insufficiency. It also suggests management of these patients before and afterinvasive nephrological procedures including renal transplantation