Are There Viable Alternatives to Warfarin in a Patient With Renal Disease on Hemodialysis?

摘要

Acute venous thromboembolism (VTE), consisting of deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a commonly encountered clinical scenario. Patients with acute VTE events can be effectively treated with various oral anticoagulants (warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban) that have demonstrated efficacy and relative safety. Usually, the factors influencing the choice of agent are relatively easy to navigate: cost, patient preferences, physician experience and preferences, potential drug-drug interactions, and in the case of warfarin, a patient's willingness or ability to frequently present to the clinic for international normalized ratio (INR) monitoring. However, certain infrequently encountered clinical conditions that are outside of the clinical trial parameters for these agents can create a more difficult decision.