Warfarin use in hemodialysis patients: what is the risk?

Hdl Handle:
http://hdl.handle.net/10147/126095
Title:
Warfarin use in hemodialysis patients: what is the risk?
Authors:
Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J
Affiliation:
Department of Nephrology, 2Department of Haematology, 3Department of Computer Science, and 4HIPE Department, Beaumont Hospital, Dublin, Ireland.
Citation:
Warfarin use in hemodialysis patients: what is the risk? 2011, 75 (3):204-11 Clin. Nephrol.
Journal:
Clinical nephrology
Issue Date:
Mar-2011
URI:
http://hdl.handle.net/10147/126095
PubMed ID:
21329630
Abstract:
Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
Item Type:
Article
Language:
en
ISSN:
0301-0430

Full metadata record

DC FieldValue Language
dc.contributor.authorPhelan, P Jen
dc.contributor.authorO'Kelly, Pen
dc.contributor.authorHolian, Jen
dc.contributor.authorWalshe, J Jen
dc.contributor.authorDelany, Cen
dc.contributor.authorSlaby, Jen
dc.contributor.authorWinders, Sen
dc.contributor.authorO'Toole, Den
dc.contributor.authorMagee, Cen
dc.contributor.authorConlon, P Jen
dc.date.accessioned2011-03-29T14:00:58Z-
dc.date.available2011-03-29T14:00:58Z-
dc.date.issued2011-03-
dc.identifier.citationWarfarin use in hemodialysis patients: what is the risk? 2011, 75 (3):204-11 Clin. Nephrol.en
dc.identifier.issn0301-0430-
dc.identifier.pmid21329630-
dc.identifier.urihttp://hdl.handle.net/10147/126095-
dc.description.abstractBackground: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.-
dc.language.isoenen
dc.titleWarfarin use in hemodialysis patients: what is the risk?en
dc.typeArticleen
dc.contributor.departmentDepartment of Nephrology, 2Department of Haematology, 3Department of Computer Science, and 4HIPE Department, Beaumont Hospital, Dublin, Ireland.en
dc.identifier.journalClinical nephrologyen
dc.description.provinceLeinster-
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