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    Influence of Renal Function on the Pharmacokinetics, Pharmacodynamics, Efficacy, and Safety of Non-Vitamin K Antagonist Oral Anticoagulants

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    Author
    Weir, M.R.
    Kreutz, R.
    Date
    2018
    Journal
    Mayo Clinic Proceedings
    Publisher
    Elsevier Ltd
    Type
    Review
    
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    See at
    https://dx.doi.org/10.1016/j.mayocp.2018.06.018
    Abstract
    With the growing integration of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice, questions have arisen regarding their use in special populations, including groups that may have been underrepresented in clinical trials. Patients with renal impairment, particularly in the lower echelons of renal function, are one such group. In an effort to elucidate the current evidence regarding the use of NOACs in patients with renal impairment, a systematic assessment of the literature was performed. The MEDLINE database was interrogated for studies and analyses evaluating the influence of renal function on the pharmacokinetics, pharmacodynamics, efficacy, and safety of NOACs published from January 1, 2000, through August 2, 2017. The 82 relevant publications retrieved highlight the diversity in the NOAC class regarding the impact of renal function on drug clearance, drug exposures, and clinical trial outcomes. In several large clinical trials, subgroup analyses revealed no significant differences when patients were stratified by creatinine clearance as a measure of renal function. Efficacy findings, in particular, were largely aligned with the overall population in the included studies. However, relative risks of bleeding were shown to vary, sometimes driven by changes in bleeding event rates in the comparator arm (eg, warfarin, enoxaparin). With few exceptions, minimal influence of mild renal impairment was observed on the relative efficacy and safety of NOACs. Taken together, the evidence suggests that the presence of renal impairment merits careful consideration of anticoagulant choice but should not deter physicians from appropriate use of NOACs. © 2018 Mayo Foundation for Medical Education and Research
    Keyword
    non-vitamin K antagonist oral anticoagulants
    Anticoagulants--pharmacokinetics
    Anticoagulants--pharmacology
    Kidney
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053054043&doi=10.1016%2fj.mayocp.2018.06.018&partnerID=40&md5=354227503b9364406f892e7a676c599f; http://hdl.handle.net/10713/8779
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.mayocp.2018.06.018
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