Oral Anticoagulant Therapy in Patients Receiving Haemodialysis: Is It Time to Abandon It?
Table 1
Factors conducive to coagulation disorders in patients with end-stage renal disease and receiving haemodialysis [8–13].
Factors conducive to bleeding events
Factors conducive to thrombosis
Directly
Platelet adhesion disorders—decreased activity of von Willebrand factor and receptor GPIb, increased release of PGI2, NO Platelet aggregation disorders—decreased activity of GPIIb/IIIa receptor, impaired binding of fibrinogen to platelets Platelet secretion disorders—decreased production of thromboxane A2, serotonin and ADP, decreased release of β-thromboglobulin, and impaired Ca++ mobilization Reduced number and volume of platelets
Accelerated atherosclerotic processes, damaged endothelium Defective GPIb expression on the surface of platelets Disorders of protein C metabolism, decreased concentration of protein C and antithrombin III Elevated concentrations of plasminogen activator inhibitor-1 (PAI-1)
Indirectly
Anaemia—altered rheological features of blood, impaired platelet aggregation Uraemic toxins—for example, PTH Medications—antiplatelet, anticoagulant, cephalosporins, antitubercular, inhibitors of lipid absorption, NSAIDs Concomitant diseases—for example, affecting the gastrointestinal tract Invasive procedures—cannulations, biopsies, vascular access
