Position paper

Blood Transfusion - 6 2020 (November-December)

Position paper on the safety/efficacy profile of direct oral anticoagulants in patients with chronic kidney disease. Consensus document from the SIN, FCSA and SISET


Key words: direct oral anticoagulants, glomerular filtration rate, elderly, polypharmacy
Publication Date: 2020-08-06


Direct oral anticoagulants (DOAC) are mostly prescribed to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation (AF). An increasing number of guidelines recommend DOAC in AF patients with preserved renal function for the prevention of thromboembolism, and an increased use of DOAC in daily practice has been recorded also in elderly patients. Ageing is associated with a reduction in glomerular filtration rate, and impaired renal function, regardless of the cause, increases the risk of bleeding. Multiple medication use (polypharmacy) for treating superimposed co-morbidities is common in both elderly and chronic kidney disease (CKD) patients and drug-drug interaction may cause accumulation of DOAC, thereby increasing the risk of bleeding. The safety profile of DOAC in patients with CKD has not been defined with any certainty, particularly in those with severely impaired renal function or end stage renal disease. This has been due to the heterogeneity of studies and the relative paucity of data. This document reports the position of three Italian scientific societies engaged in the management of patients with atrial fibrillation who are treated with DOAC and present with CKD.



Elvira Grandone - Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy; Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia

Filippo Aucella - Nephrology and Dialysis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

Doris Barcellona - Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; 5Nephrology and Dialysis Unit

Giuliano Brunori - Nephrology and Dialysis Unit, "S. Chiara Hospital”, Trento, Italy

Giacomo Forneris - Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

Paolo Gresele - Department of Medicine - Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy

Marco Marietta - Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy

Daniela Poli - Center for Atherothrombotic Diseases, “Careggi” University Hospital, Florence, Italy

Sophie Testa - Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy

Armando Tripodi - Fondazione IRCCS “Ca’ Granda Ospedale Maggiore Policlinico”, “Angelo Bianchi Bonomi” Hemophilia and Thrombosis Center and “Fondazione Luigi Villa”, Milan, Italy

Simonetta C. Genovesi - Department of Medicine and Surgery, University of Milano-Bicocca, Monza and Nephrology Unit, “San Gerardo” Hospital, Monza, Italy

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