Anticoagulant use in patients with chronic renal impairment

被引：76

作者：

Grand'Maison A. ^{[1
,4
]}

Charest A.F. ^{[2
]}

Geerts W.H. ^{[3
]}

机构：

[1] Department of Medicine, University Health Network, University of Toronto, Toronto, Ont.

[2] Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont.

[3] Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ont.

[4] Toronto General Hospital, University Health Network, Toronto, Ont. M5G 2N2

来源：

American Journal of Cardiovascular Drugs | 2005年 / 5卷 / 5期

关键词：

Renal Impairment; International Normalize Ratio; Bivalirudin; Severe Renal Impairment; Activate Clotting Time;

D O I：

10.2165/00129784-200505050-00002

中图分类号：

学科分类号：

摘要：

Patients with renal failure have an increased risk of both thrombotic and bleeding complications. A number of antithrombotic drugs undergo renal clearance. Therefore, estimation of renal function is necessary when prescribing these drugs to patients with renal dysfunction. Pharmacokinetic and clinical data in patients with chronic renal impairment are limited for several anticoagulants, and adequate administration information is often absent. Dose adjustment of anticoagulants may be indicated when the creatinine clearance falls below 30 mL/min. Unfractionated heparin, argatroban, and vitamin K antagonists generally do not require dose adjustment with renal dysfunction. However, smaller doses of warfarin may be required to achieve a particular target international normalized ratio. Close monitoring of anticoagulation is recommended when argatroban or high doses of unfractionated heparin are administered in patients with severe chronic renal impairment. Low-molecular weight heparins, danaparoid sodium, hirudins, and bivalirudin all undergo renal clearance. Lower doses and closer anticoagulation monitoring may be advisable when these agents are used in patients with chronic renal failure. We recommend that fondaparinux sodium and ximelagatran (not yet licensed) be avoided in the presence of severe renal impairment and be used with caution in patients with moderate renal dysfunction. While acknowledging the lack of pharmacokinetic data, this review provides specific recommendations for the use of anticoagulants in patients with chronic renal impairment. © 2005 Adis Data Information BV. All rights reserved.

引用

页码：291 / 305

页数：14

共 97 条

[61]

Jang I.K., Brown D.F., Giugliano R.P., Et al., A multicenter, randomized study of argatroban versus heparin as adjunct to tissue plasminogen activator (TPA) in acute myocardial infarction: Myocardial Infarction with Novastan and TPA (MINT) study, J Am Coll Cardiol, 33, pp. 1879-1885, (1999)

[62]

Eriksson U.G., Bredberg U., Hoffmann K.J., Et al., Absorption, distribution, metabolism, and excretion of ximelagatran, an oral direct thrombin inhibitor, in rats, dogs, and humans, Drug Metab Dispos, 31, pp. 294-305, (2003)

[63]

Gustafsson D., Elg M., The pharmacodynamics and pharmacokinetics of the oral direct thrombin inhibitor ximelagatran and its active metabolite melagatran: A mini-review, Thromb Res, 109, 1 SUPPL., (2003)

[64]

Colwell C.W., Berkowitz S.D., Davidson B.L., Et al., Comparison of ximelagatran, an oral direct thrombin inhibitor, with enoxaparin for the prevention of venous thromboembolism following total hip replacement: A randomized, double-blind study, J Thromb Haemost, 1, pp. 2119-2130, (2003)

[65]

Eriksson B.I., Agnelli G., Cohen A.T., Et al., Direct thrombin inhibitor melagatran followed by oral ximelagatran in comparison with enoxaparin for prevention of venous thromboembolism after total hip or knee replacement, Thromb Haemost, 89, pp. 288-296, (2003)

[66]

Francis C.W., Berkowitz S.D., Comp P.C., Et al., Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement, N Engl J Med, 349, pp. 1703-1712, (2003)

[67]

Eriksson B.I., Bergqvist D., Kalebo P., Et al., Ximelagatran and melagatran compared with dalteparin for prevention of venous thromboembolism after total hip or knee replacement: The METHRO II randomised trial, Lancet, 360, pp. 1441-1447, (2002)

[68]

Eriksson B.I., Arfwidsson A.C., Frison L., Et al., A dose-ranging study of the oral direct thrombin inhibitor, ximelagatran, and its subcutaneous form, melagatran, compared with dalteparin in the prophylaxis of thromboembolism after hip or knee replacement: METHRO I. MElagatran for THRombin inhibition in Orthopaedic surgery, Thromb Haemost, 87, pp. 231-237, (2002)

[69]

Eriksson B.I., Ogren M., Eriksson U.G., Et al., Prophylaxis of venous thromboembolism with subcutaneous melagatran in total hip or total knee replacement: Results from Phase II studies, Thromb Res, 105, pp. 371-378, (2002)

[70]

Eriksson H., Eriksson U.G., Frison L., Et al., Pharmacokinetics and pharmacodynamics of melagatran, a novel synthetic LMW thrombin inhibitor, in patients with acute DVT, Thromb Haemost, 81, pp. 358-363, (1999)

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