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Anticoagulant-related nephropathy induced by direct-acting oral anticoagulants: Clinical characteristics, treatments and outcomes

  • Shanshan Chen
    Affiliations
    Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
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  • Dehua Liao
    Affiliations
    Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
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  • Minghua Yang
    Correspondence
    Corresponding author.
    Affiliations
    Postdoctoral Research Station of Clinical Medicine and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
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  • Shengfeng Wang
    Correspondence
    Corresponding author at: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
    Affiliations
    Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China

    Postdoctoral Research Station of Clinical Medicine and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China

    Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
    Search for articles by this author
Published:December 17, 2022DOI:https://doi.org/10.1016/j.thromres.2022.12.002

      Abstract

      Introduction

      There is a scarcity of data on anticoagulation-related nephropathy (ARN) caused by direct-acting oral anticoagulants (DOACs) in recent years.

      Materials and methods

      We collected literatures on DOACs-induced ARN to October 1, 2022, without language restrictions for retrospective analysis.

      Results

      Twenty events were included with a median onset time of 28 days among which fourteen were caused by dabigatran. Patients accompanied by chronic kidney disease (85 %) seemed more easily to have an ARN. Clinical symptoms associated with ARN were mostly presented as hematuria and acute decline of renal function (100 %), then abnormal coagulation function (75 %) but only one with an INR over 3. Renal biopsies were performed in 14 patients, with thirteen showing occlusive intratubular red blood cell casts and ten showing acute tubular injury of varying intensity or even tubular necrosis. Extensive changes in interstitial compartment like hemorrhage, fibrosis or inflammation were also presented in eight biopsies. IgA nephropathy as a latent or undiagnosed disease was demonstrated in eight biopsies. Treatments of ARN were mainly supportive with all patients discontinuing DOACs and 35 % initiating dialysis for acute deterioration of renal function. Steroids were used in 9 patients with a severe ARN verified by biopsy. 60 % of patients did not recover baseline renal function and some even deteriorated.

      Conclusions

      In conclusion, DOACs-induced ARN is a rare but serious adverse reaction. A prompt diagnosis of ARN and supportive treatments are necessary for patients receiving DOACs concurrent with an acute renal injury.

      Keywords

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