Pulmonary embolism (PE) is associated with adverse outcomes and substantial morbidity and mortality. Patients with PE often have renal impairment because of shared risk factors and close links between the renal and cardiovascular systems. Furthermore, patients with PE and renal impairment are at increased risk of recurrent thrombosis. Therefore, anticoagulation is crucial to treat the acute event, prevent recurrent venous thromboembolism (VTE), and optimize patient outcomes. However, when treated with an anticoagulant, patients with renal impairment also have an elevated risk of bleeding. Direct oral anticoagulants (DOACs) are the first-choice treatment for acute VTE in eligible patients. However, as all DOACs have a degree of renal excretion, the management of anticoagulation therapy can be more complicated in patients with renal impairment. This review provides an overview of the clinical challenges of managing anticoagulation in patients with PE and renal impairment and explores the optimal practice management of this special patient group.
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