ความสัมพันธ์ของการเกิดโรคไตกับการใช้ยาต้านการแข็งตัวของเลือด

Supawiwatch  Rodjanasingha; Sirigunya  Rodjanasingha

Authors

Supawiwatch Rodjanasingha Division of Nephrology, Department of Internal Medicine, Hua Hin Hospital, Prachuap Khiri Khan, Thailand
Sirigunya Rodjanasingha Department of Internal Medicine, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Keywords:

Warfarin, Direct oral anticoagulants, Acute kidney injury, Chronic kidney disease

Abstract

Introduction: Anticoagulant-related nephropathy (ARN) is a significant and often under-recognized complication that leads to acute kidney injury (AKI) and an accelerated chronic kidney disease (CKD) progression.

Objective: To systematically review the epidemiology, pathophysiology, risk factors, diagnosis, management and preventive strategies for ARN.

Methods: A literature review was conducted by synthesizing data from studies published in the PubMed and Scopus databases between 2009 and 2024, regarding ARN in patients receiving Warfarin and other direct oral anticoagulants (DOACs).

Results: ARN results from two primary mechanisms: 1) glomerular hemorrhage due to the loss of thrombin's cytoprotective signaling, and 2) the tubular obstruction by red blood cell casts, leading to AKI. The key risk factor is excessive anticoagulation, particularly in patients with pre-existing CKD. Although DOACs are associated with a lower overall risk of AKI as compared to Warfarin, they can still induce ARN. Diagnosis is primarily based on clinical criteria due to the high risk of renal biopsy. The cornerstone of management is the prompt cessation of anticoagulation and reversal of coagulopathy.

Conclusion: ARN is a serious but preventable complication. Rigorous monitoring of renal functions and coagulation levels, along with the appropriate adjustments to dosage are crucial to mitigate risk and reduce patient mortality.

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