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Chronic kidney disease, being a “prothrombic state,” would seem to warrant use of anticoagulants, yet they aren’t often used — why? The problem seems to be a lack of data with which to evaluate their effectiveness and possible harms. Big drug trials seem to avoid recruiting these patients, especially those in the later stages of CKD, where, for example, the risk for thromboembolism is two- to three-fold greater than in patients with normal kidney function.
We talk with Dr. Sunil Badve, senior author of a meta-analysis in a recent Annals of Internal Medicine. His findings? Non-vitamin K oral anticoagulants (or “NOACs”) seem better suited for those with early-stage disease than vitamin K antagonists like warfarin. In later-stage CKD, there just isn’t enough data available yet, and so the choice of therapy — if any — must weigh benefits against harms carefully.