acenocoumarol and Kidney-Diseases

Venous thromboembolism (VTE) is a common and serious complication in patients with cancer; treatment guidelines recommend extended therapy of ≥6 months with low-molecular-weight heparin (LMWH) for treatment and prevention of recurrent VTE (rVTE) in this population. This post hoc analysis used data from the CLOT study-a phase III, randomized, open-label, controlled study (N = 676)-to compare the efficacy and safety of dalteparin, a LMWH, versus vitamin K antagonist (VKA) for prevention of rVTE in patients with cancer and renal impairment (creatinine clearance <60 ml/min). Overall, 162/676 (24 %) patients had renal impairment at baseline. Patients received subcutaneous dalteparin 200 IU/kg once daily during month 1, followed by 150 IU/kg once daily for months 2-6; or VKA once daily for 6 months, with initial overlapping subcutaneous dalteparin 200 IU/kg once daily for ≥5 days until international normalized ratio was 2.0-3.0 for 2 consecutive days. Endpoints included the rates of rVTE (primary) and bleeding events. Overall, fewer dalteparin-treated patients (2/74 [2.7 %]) experienced ≥1 adjudicated symptomatic rVTE compared with VKA-treated patients (15/88 [17.0 %]; hazard ratio = 0.15 [95 % confidence interval 0.03-0.65]; p = 0.01). Bleeding event rates for both treatments were similar (p = 0.47). In summary, compared with VKA, dalteparin significantly reduced risk of rVTE in patients with cancer and renal impairment (p = 0.01) while exhibiting a comparable safety profile. This analysis supports dosing patients with renal impairment in accordance with patients with normal renal function; however, anti-Xa monitoring could be considered to further support safety in selected patients, particularly those with very severe renal impairment.

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Dalteparin; Female; Humans; Kidney Diseases; Male; Middle Aged; Neoplasms; Venous Thromboembolism; Vitamin K; Warfarin

Warfarin-related nephropathy.. Warfarin.. A 31-year-old female, managed with warfarin for rheumatic heart disease with atrial fibrillation.. There were no alternative causes of nephropathy that could have caused the adverse event in this patient.. Shifting the drug from warfarin to acenocoumarol.. Difference in renal elimination between warfarin and acenocoumarol.. Clinicians should be aware of this rare adverse effect of warfarin, and acenocoumarol can be considered as an alternative therapy for this condition.. Further prospectively designed studies are needed to consider acenocoumarol as an alternative therapy in warfarin-related nephropathy.

Topics: Acenocoumarol; Adult; Anticoagulants; Atrial Fibrillation; Female; Humans; Kidney Diseases; Rheumatic Heart Disease; Warfarin

Topics: Acenocoumarol; Allopurinol; Chloramphenicol; Chlorpropamide; Clofibrate; Glomerular Filtration Rate; Glomerulonephritis; Half-Life; Humans; Kidney; Kidney Diseases; Probenecid; Pyelonephritis

Topics: Acenocoumarol; Acute Disease; Blood Coagulation Disorders; Chemical and Drug Induced Liver Injury; Child, Preschool; Factor VII; Factor VIII; Factor X; Hemorrhage; Humans; Kidney Diseases; Kidney Function Tests; Liver Function Tests; Male; Medication Errors; Prothrombin; Prothrombin Time; Vitamin K