Antithrombotic Therapy in Chronic Kidney Disease

Abstract Chronic kidney disease (CKD) affects over 10% of the global population and is more prevalent in the elderly, females, patients with diabetes or hypertension, and certain racial minorities. CKD is a leading cause of mortality, especially in CKD stage G5 and End-Stage Renal Disease (ESRD). Left ventricular hypertrophy (LVH) is common in CKD patients, predicting mortality even in early stages. CKD patients face a higher risk of bleeding, with a 3.5 times higher risk in hemodialysis patients. Atrial fibrillation (AF) and acute coronary syndrome are more prevalent in patients with eGFR <60 ml/min, and the risk of pulmonary embolism increases by 25-30% regardless of CKD stage. Antithrombotic treatment is crucial for CKD patients with cardiovascular diseases. In early stages (G1-G3), both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) can be used, with NOACs preferred due to their safety profile. In advanced stages (G4-G5) and ESRD (G5D), warfarin is commonly used, with reduced NOAC doses as an option. NOACs require careful monitoring of renal function, and hemodialysis can remove a significant portion of plasma dabigatran. Monitoring renal function is vital for CKD patients receiving NOACs. Some studies suggest NOACs may have a lower risk of cardiovascular events compared to warfarin, but conflicting data exist regarding bleeding risk. Individualized treatment decisions should consider the patient's renal function.