Mital Jhaveri: Anticoagulation in Advanced CKD – Why Individualized Decisions Matter
Mital Jhaveri, Clinical Anticoagulation, Heart Failure Pharmacist at NYC HHC Queens Hospital Center, shared a post on LinkedIn about a recent article by Kathrine Parker et al., published in BMC Nephrology Journals, adding:
“Anticoagulation in advanced kidney disease: when both clotting and bleeding risk are high, what is the right choice?
A newly published 2026 guideline highlights a challenge we face frequently in practice: patients with advanced CKD have increased risks of stroke, systemic embolism, and bleeding – yet they have historically been excluded from many major anticoagulation trials.
One particularly striking point: major DOAC trials largely excluded patients with CrCl less than 30 mL/min, leaving us with limited high-quality evidence precisely where thrombotic and bleeding risks are both high.
As a pharmacist working in anticoagulation, this reinforces that anticoagulation is never simply about choosing a drug and dose.
Renal function, bleeding risk, stroke risk, monitoring, and the individual patient all matter.
The best anticoagulation decision is an individualized one.”
Title: Anticoagulation for atrial fibrillation in adults with advanced kidney disease: UK kidney association clinical practice guideline
Authors: Kathrine Parker, Albert Power, Richard Buka, Mark Davies, Maria A. Gauci, Alan Hancock, John Hartemink, Anneka Mitchell, Honey Thomas, Jung Yin Tsang, Isaac Tseng, Andrew Turley, Gregory Y. H.
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