From the Research
For patients undergoing arthroplasty with chronic kidney disease (CKD), direct oral anticoagulants (DOACs) are associated with a lower risk of venous thromboembolism (VTE) and a higher risk of hemorrhage compared to low-molecular-weight heparin (LMWH), as shown in a recent study 1. The study found that DOAC users had a lower risk of VTE (1.5% vs. 2.1%) and a higher risk of hemorrhage (1.3% vs. 1.0%) compared to LMWH users. Given the potential benefits and risks, the choice of anticoagulant should be individualized based on the patient's specific risk factors and renal function. Some key considerations include:
- The use of DOACs, such as rivaroxaban, which was the predominant DOAC used in the study 1
- The use of LMWH, such as enoxaparin, at reduced doses for patients with CKD stage 3-4 or 5
- The importance of monitoring renal function and adjusting anticoagulant doses accordingly
- The use of mechanical prophylaxis with compression devices to minimize bleeding complications It is also important to note that the study found that DOAC users had higher eGFRs and fewer co-morbidities compared to LMWH users, which may have influenced the results. Overall, the decision to use DOACs or LMWH in patients with CKD undergoing arthroplasty should be based on a careful assessment of the individual patient's risk factors and renal function, as well as consideration of the potential benefits and risks of each anticoagulant option, as supported by the most recent and highest quality study 1.