Anticoagulation for venous thromboembolism in adults with advanced kidney disease: UK Kidney Association clinical practice guideline

Abstract Patients with chronic kidney disease (CKD) have an increased risk of developing venous thromboembolism (VTE), with the risk increasing as kidney function declines. Those with CKD who develop VTE have higher rates of mortality compared to those with normal kidney function. Despite the increased thromboembolic risk associated with CKD, patients with advanced CKD simultaneously have a higher risk of bleeding. Following results from large randomised controlled trials treatment of VTE has in the mainstay shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). DOACs have been shown to have lower rates of major bleeding with similar rates of VTE recurrence alongside simpler dosing and monitoring regimes in the general population. Due to the increased risk of VTE patients with kidney disease admitted to hospital need a VTE risk assessment and use of VTE thromboprophylaxis if indicated. However, trials of low molecular weight heparin (LMWH) and DOACs excluded patients with advanced kidney disease (CrCl<30 ml/min) therefore good-quality data is limited in this population making decisions around anticoagulation challenging. These UK Kidney Association guidelines provide best-practice guidance on the use of anticoagulants for venous thromboembolism in the context of advanced CKD. There are recommendations about the use and dosing regime for LMWH, the use of DOACs, the monitoring of LMWH and DOACs and recommendations for VTE thromboprophylaxis. It also includes research recommendations.

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Publication Details

Journal
BMC Nephrology
Published
2026-09-25
DOI
https://doi.org/10.1186/s12882-026-05394-y
Primary Topic
Venous Thromboembolism Diagnosis and Management
Type
article
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article

Anticoagulation for venous thromboembolism in adults with advanced kidney disease: UK Kidney Association clinical practice guideline

Chen I. Tseng, Satarupa Choudhuri, Dr Hannah Stacey, Kate Bramham et al.
BMC Nephrology
Venous Thromboembolism Diagnosis and Management
article

Anticoagulation for venous thromboembolism in adults with advanced kidney disease: UK Kidney Association clinical practice guideline

Chen I. Tseng, Satarupa Choudhuri, Dr Hannah Stacey, Kate Bramham, Anneka Mitchell, Lara N. Roberts, Gregory Y.H. Lip, Kathrine Parker, Jung Yin Tsang, Maria Angela Gauci, Raza Alikhan, Jecko Thachil, Andrew Davenport, Katherine Stirling, Susie Shapiro, Albert Power, Richard; id_orcid 0000-0002-2738-6236 Buka, Charles Ferro, P Lewis, Lara Roberts, David Sutton, Mark Davies, Yvonne Bernes, Ed Jenkinson, Donna Lewis, Lauren Hall, the guideline authors, Will Thomas, Nicola Lewis, Sandip Mitra, Philip Kalra, Alexander Cohen, Huw Roswell, Gregory Y. H. Lip, John Hartemink, Katy Mills
article en

Abstract

Abstract Patients with chronic kidney disease (CKD) have an increased risk of developing venous thromboembolism (VTE), with the risk increasing as kidney function declines. Those with CKD who develop VTE have higher rates of mortality compared to those with normal kidney function. Despite the increased thromboembolic risk associated with CKD, patients with advanced CKD simultaneously have a higher risk of bleeding. Following results from large randomised controlled trials treatment of VTE has in the mainstay shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). DOACs have been shown to have lower rates of major bleeding with similar rates of VTE recurrence alongside simpler dosing and monitoring regimes in the general population. Due to the increased risk of VTE patients with kidney disease admitted to hospital need a VTE risk assessment and use of VTE thromboprophylaxis if indicated. However, trials of low molecular weight heparin (LMWH) and DOACs excluded patients with advanced kidney disease (CrCl<30 ml/min) therefore good-quality data is limited in this population making decisions around anticoagulation challenging. These UK Kidney Association guidelines provide best-practice guidance on the use of anticoagulants for venous thromboembolism in the context of advanced CKD. There are recommendations about the use and dosing regime for LMWH, the use of DOACs, the monitoring of LMWH and DOACs and recommendations for VTE thromboprophylaxis. It also includes research recommendations.

BMC Nephrology
University of Essex (GB), North Bristol NHS Trust (GB), St Thomas' Hospital (GB), University of Liverpool (GB), King's College London (GB), Leeds Teaching Hospitals NHS Trust (GB), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), South Essex Partnership University Foundation NHS Trust (GB), University of Manchester (GB), Northern Health and Social Care Trust (GB), University of Bristol (GB), Manchester University NHS Foundation Trust (GB), King's College Hospital NHS Foundation Trust (GB), Mid Essex Hospital Services NHS Trust (GB), University Hospitals Plymouth NHS Trust (GB), Aalborg University (DK)
Good health and well-being
Openalex Percentile: Top 9%
Venous Thromboembolism Diagnosis and Management
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