Oral anticoagulation in chronic kidney disease

Non-vitamin K antagonist oral anticoagulants (NOAC) present several advantages over vitamin K antagonists, but data with respect to their use in patients with chronic kidney disease is limited. The decision to use oral anticoagulation as well as the choice of the molecule may be difficult in these patients. In patients with moderate kidney disease, NOACs appear to be safe and effective. In advanced kidney disease, they should be used with prudence, after careful assessment of risks and benefits, and at adapted doses. In end stage kidney disease, evidence is weak, suggesting an unfavourable risk benefit ratio. Prescription of oral anticoagulation in these patients has to be individualised in a shared decision making process.