Perspectives: Lessons Learned From VKAs

Sarah A. Spinler

Sarah A. Spinler


  • Professor of Clinical Pharmacy
  • Department of Pharmacy Practice and Pharmacy Administration
  • Philadelphia College of Pharmacy
  • University of the Sciences in Philadelphia
  • Philadelphia, Pennsylvania

How the risk of bleeding may affect the selection of an anticoagulant

One variable that may play a role in deciding which anticoagulant to use is renal dysfunction, because patients with chronic kidney disease are at higher risk for experiencing bleeding.

If there were anticoagulants that didn’t have any renal elimination, that would be preferred in patients with chronic kidney disease. We currently don’t have that option. So we have to be careful with patients who have severe renal dysfunction and those patients may require closer follow-up for bleeding complications.

Even with warfarin, patients with renal dysfunction often have bleeding issues, so it may not be the best choice for patients with renal disease. Selection of an agent for patients with renal dysfunction needs to be individualized.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.