NOAC should not be used in severe chronic kidney dysfunction. But we do not know the changes in renal function during follow-up. So, can we use these drugs in moderate chronic kidney dysfunction safely?
I would not use the drug until more data and experience is acquired. I saw one patient with mild renal failure treated with full dose argatroban that developed severe bleeding . If you want to use anyway - reduce the dosage
The problem is how I am sure that this GFR is stable. Very probably these patients may show changes in the GFR. They are old people, with heart failure, ischemic heart disease,...
Most eldely patients have stable GFR without signs of progression, Obviously, there is the risk of acute change due to intercurrent problems. Nevertheless, so we should never use renin.angiotensin axis blocking drugs in these patients. Is this reasonable?
Check blood creatinine monthly for 2 consecutive months and calculate GFR using MDRD calculator . This is the way to be sure that the renal function is stable.
If the GFR is stable redo-it every 3 months
I am completely agreed to you. We should be sure our patient show an steady renal function.
And what about differences among new OAC. Perhaps we should avoid dabigatran?
We need a useful monitoring to assess the anticoagulation level. Moreover, we need more experience about bleeding management and reversal therapies. Until additional data will be published, NOAC should be use with caution in case of kidney dysfunction.
I agree that more experience is needed in different situations (i.e. periprocedural or perioperative situations) with NOAC. Regarding its use in chronic kidney dysfunction, until new evidence, we should limit the use of these drugs in moderate dysfunction and avoid them in patients with severe impairment.
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