Warfarin use in hemodialysis patients: what is the risk?

Hdl Handle:
http://hdl.handle.net/10147/207158
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, Beaumont Hospital, Dublin 9, Ireland., paulphel@gmail.com
Citation:
Clin Nephrol. 2011 Mar;75(3):204-11.
Journal:
Clinical nephrology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207158
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.
Language:
eng
MeSH:
Aged; Anticoagulants/*adverse effects; Atrial Fibrillation/blood/complications/*drug therapy; Blood Coagulation/*drug effects; Brain Ischemia/etiology/*prevention & control; Erythrocyte Transfusion; Female; Hemorrhage/*chemically induced/therapy; Hospitalization; Humans; International Normalized Ratio; Ireland; Length of Stay; Male; Renal Dialysis/*adverse effects; Retrospective Studies; Risk Assessment; Risk Factors; Stroke/etiology/*prevention & control; Warfarin/*adverse effects
ISSN:
0301-0430 (Print); 0301-0430 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorPhelan, P Jen_GB
dc.contributor.authorO'Kelly, Pen_GB
dc.contributor.authorHolian, Jen_GB
dc.contributor.authorWalshe, J Jen_GB
dc.contributor.authorDelany, Cen_GB
dc.contributor.authorSlaby, Jen_GB
dc.contributor.authorWinders, Sen_GB
dc.contributor.authorO'Toole, Den_GB
dc.contributor.authorMagee, Cen_GB
dc.contributor.authorConlon, P Jen_GB
dc.date.accessioned2012-02-01T10:00:39Z-
dc.date.available2012-02-01T10:00:39Z-
dc.date.issued2012-02-01T10:00:39Z-
dc.identifier.citationClin Nephrol. 2011 Mar;75(3):204-11.en_GB
dc.identifier.issn0301-0430 (Print)en_GB
dc.identifier.issn0301-0430 (Linking)en_GB
dc.identifier.pmid21329630en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207158-
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.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnticoagulants/*adverse effectsen_GB
dc.subject.meshAtrial Fibrillation/blood/complications/*drug therapyen_GB
dc.subject.meshBlood Coagulation/*drug effectsen_GB
dc.subject.meshBrain Ischemia/etiology/*prevention & controlen_GB
dc.subject.meshErythrocyte Transfusionen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHemorrhage/*chemically induced/therapyen_GB
dc.subject.meshHospitalizationen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInternational Normalized Ratioen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshLength of Stayen_GB
dc.subject.meshMaleen_GB
dc.subject.meshRenal Dialysis/*adverse effectsen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshStroke/etiology/*prevention & controlen_GB
dc.subject.meshWarfarin/*adverse effectsen_GB
dc.titleWarfarin use in hemodialysis patients: what is the risk?en_GB
dc.contributor.departmentDepartment of Nephrology, Beaumont Hospital, Dublin 9, Ireland., paulphel@gmail.comen_GB
dc.identifier.journalClinical nephrologyen_GB
dc.description.provinceLeinster-
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