Chronic renal insufficiency influences haemostasis through different mechanisms which result either in an anticoagulatory state characterized by recurrent thrombosis or in a procoagulatory state characterized by episodes of bleeding. The risk of developing either thrombosis or bleeding might be associated with the severity of renal dysfunction with advanced renal failure being associated with bleeding, while renal failure with moderately preserved renal function is more associated with thrombosis. The picture is further complicated through anticoagulatory drugs that need to be administered in patients with renal insufficiency as they suffer from significant cardiovascular comorbidity requiring anticoagulation.
While the relative role of both components remains to be determined, anticoagulant drugs should be well chosen and carefully dosed in patients with renal impairment. Monitoring is helpful particularly to detect accumulation and to optimize anticoagulant therapy.