Anticoagulation for venous thromboembolism in adults with advanced kidney disease: UK Kidney Association clinical practice guideline

Abstract Patients with chronic kidney disease (CKD) have an increased risk of developing venous thromboembolism (VTE), with the risk increasing as kidney function declines. Those with CKD who develop VTE have higher rates of mortality compared to those with normal kidney function. Despite the increased thromboembolic risk associated with CKD, patients with advanced CKD simultaneously have a higher risk of bleeding. Following results from large randomised controlled trials treatment of VTE has in the mainstay shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). DOACs have been shown to have lower rates of major bleeding with similar rates of VTE recurrence alongside simpler dosing and monitoring regimes in the general population. Due to the increased risk of VTE patients with kidney disease admitted to hospital need a VTE risk assessment and use of VTE thromboprophylaxis if indicated. However, trials of low molecular weight heparin (LMWH) and DOACs excluded patients with advanced kidney disease (CrCl<30 ml/min) therefore good-quality data is limited in this population making decisions around anticoagulation challenging. These UK Kidney Association guidelines provide best-practice guidance on the use of anticoagulants for venous thromboembolism in the context of advanced CKD. There are recommendations about the use and dosing regime for LMWH, the use of DOACs, the monitoring of LMWH and DOACs and recommendations for VTE thromboprophylaxis. It also includes research recommendations.