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diabetes stroke dialysis anticoagulant

Tatjana S Potpara, Charles J Ferro, Gregory Y H Lip
Atrial fibrillation (AF) and chronic kidney disease (CKD) are increasingly prevalent in the general population and share common risk factors such as older age, hypertension and diabetes mellitus. The presence of CKD increases the risk of incident AF, and, likewise, AF increases the risk of CKD development and/or progression. Both conditions are associated with substantial thromboembolic risk, but patients with advanced CKD also exhibit a paradoxical increase in bleeding risk. In the landmark randomized clinical trials that compared non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for thromboprophylaxis in patients with AF, the efficacy and safety of NOACs in patients with mild-to-moderate CKD were similar to those in patients without CKD...
May 2018: Nature Reviews. Nephrology
Mark C Lin, Elani Streja, Melissa Soohoo, Medhat Hanna, Javad Savoj, Kamyar Kalantar-Zadeh, Wei Ling Lau
BACKGROUND: Controversy exists regarding the benefits and risks of warfarin therapy in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In this study, we assessed mortality and cardiovascular outcomes associated with warfarin treatment in patients with stages 3-5 CKD and ESRD admitted to the University of California-Irvine Medical Center. METHODS: In a retrospective matched cohort study, we identified 59 adult patients with stages 3-6 CKD initiated on warfarin during the period 2011-2013, and 144 patients with stages 3-6 CKD who had indications for anticoagulation therapy but were not initiated on warfarin...
2017: American Journal of Nephrology
S Nayak-Rao, M P Shenoy
Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit...
May 2017: Indian Journal of Nephrology
Lohit Garg, Charity Chen, David E Haines
INTRODUCTION: Warfarin therapy for stroke prevention is recommended for patients with AF, but its value in patients with chronic kidney disease on HD is unknown. METHODS: The anticoagulation regimens of patients with a prior history of AF hospitalized for initiation of chronic HD, and of patients receiving chronic HD who had a new diagnosis of AF between 2009 and 2012 were reviewed. Exclusions were renal transplant, peritoneal dialysis, rheumatic valve disease, prosthetic heart valve, GI bleeding, malignancy with chemotherapy in last 6months or still undergoing treatment, a history of AF ablation, a history of ICD implantation, or those receiving warfarin for non-AF indications...
November 1, 2016: International Journal of Cardiology
Benjamin A Steinberg, Sunghee Kim, Laine Thomas, Gregg C Fonarow, Elaine Hylek, Jack Ansell, Alan S Go, Paul Chang, Peter Kowey, Bernard J Gersh, Kenneth W Mahaffey, Daniel E Singer, Jonathan P Piccini, Eric D Peterson
BACKGROUND: Physicians treating patients with atrial fibrillation (AF) must weigh the benefits of anticoagulation in preventing stroke versus the risk of bleeding. Although empirical models have been developed to predict such risks, the degree to which these coincide with clinicians' estimates is unclear. METHODS AND RESULTS: We examined 10 094 AF patients enrolled in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) registry between June 2010 and August 2011...
May 20, 2014: Circulation
Albert Power
BACKGROUND: Renal impairment is a potent risk factor for stroke that is a leading cause of morbidity and mortality worldwide. Dialysis patients experience a 10-fold higher incidence, with case fatality rates reaching 90%. It is important to understand the factors predisposing to stroke in patients with chronic kidney disease (CKD) coupled with an appreciation of preventative strategies. SUMMARY: The heightened risk of stroke in CKD represents the interplay of the vascular comorbidities that cluster with renal impairment as well as pathology inherent in uremia, such as accelerated vascular calcification and the malnutrition-inflammation-atherosclerosis syndrome...
2013: Blood Purification
Mitesh Shah, Meytal Avgil Tsadok, Cynthia A Jackevicius, Vidal Essebag, Mark J Eisenberg, Elham Rahme, Karin H Humphries, Jack V Tu, Hassan Behlouli, Helen Guo, Louise Pilote
BACKGROUND: Current observational studies on warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation (AF) undergoing dialysis found conflicting results. METHODS AND RESULTS: We conducted a population-based retrospective cohort study of patients aged ≥65 years admitted to a hospital with a primary or secondary diagnosis of AF, in Quebec and Ontario, Canada from 1998 to 2007. The AF cohort was grouped into dialysis (hemodialysis and peritoneal dialysis) and nondialysis patients and into warfarin and no-warfarin users according to the first prescription filled for warfarin within 30 days after AF hospital discharge...
March 18, 2014: Circulation
Kazunori Toyoda
Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis...
2013: Contributions to Nephrology
Catherine M Clase, Rachel M Holden, Manish M Sood, Claudio Rigatto, Louise M Moist, Benjamin K A Thomson, Johannes F E Mann, Deborah L Zimmerman
Atrial fibrillation is prevalent in dialysis patients. Both ischaemic and haemorrhagic stroke are common in patients on dialysis with atrial fibrillation. In the general population, warfarin is highly effective for prophylaxis of ischaemic stroke, and though warfarin use likely increases the risk of intracranial haemorrhage, the absolute increase in risk is small. In the general population, absolute and relative increases in major extracranial bleeding from warfarin use are also both modest. In patients on dialysis, the effectiveness of warfarin as a prophylaxis for ischaemic stroke and its effects on intracranial or extracranial bleeding have not been assessed in randomized trials...
October 2012: Nephrology, Dialysis, Transplantation
Giacomo Bianchi, Marco Solinas, Stefano Bevilacqua, Mattia Glauber
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with chronic kidney disease who required dialysis that undergo valve surgery have better surgical recovery rates with bioprostheses than with mechanical valves. Altogether more than 96 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
September 2012: Interactive Cardiovascular and Thoracic Surgery
Longhui Cao, Scott Silvestry, Ning Zhao, James Diehl, Jianzhong Sun
BACKGROUND AND OBJECTIVE: Postoperative cardiocerebral and renal complications are a major threat for patients undergoing cardiac surgery. This study was aimed to examine the effect of preoperative aspirin use on patients undergoing cardiac surgery. METHODS: An observational cohort study was performed on consecutive patients (n = 1879) receiving cardiac surgery at this institution. The patients excluded from the study were those with preoperative anticoagulants, unknown aspirin use, or underwent emergent cardiac surgery...
2012: PloS One
Naohiro Shibuya, Colby H Frost, Jason D Campbell, Matthew L Davis, Daniel C Jupiter
The incidence of deep vein thrombosis (DVT) after foot and ankle surgery is generally believed to be low. However, little information is available regarding DVT as it specifically relates to foot and ankle trauma. The National Trauma Data Bank data set (2007 to 2009) was used to evaluate the incidence of thromboembolism in foot and ankle trauma. Also, the risk factors associated with the thromboembolic events were identified. Data regarding the demographics, comorbidities, procedures, trauma types, and complications, including DVT and pulmonary embolism (PE), were collected from the data set for analysis...
January 2012: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Albert Power, Kakit Chan, Seema K Singh, David Taube, Neill Duncan
BACKGROUND: Stroke incidence in hemodialysis patients is up to 10 times greater than in the general population and is associated with a worse prognosis. Factors influencing stroke risk by subtype and subsequent prognosis are poorly described in the literature. STUDY DESIGN: Retrospective single-center cohort study. SETTING & PARTICIPANTS: 2,384 established maintenance hemodialysis patients at a single center from January 1, 2002, to June 1, 2009...
February 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
George Tsagalis, Nerantzoula Bakirtzi, Efstathios Manios, Ioannis Chouliaras, Parthenia Papagiannidou, Eleni Stamellou, Theodore Akrivos, Fotis Makris, Erasinia Psimenou, George Koutroubas, Koustantinos Xinos, Koustantinos Vemmos
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, is associated with increased mortality and cardiovascular morbidity both in nonuremic and (recently) in dialysis patients. The aims of this study are: (i) to assess the prevalence of AF, the risk factors, and predictors of its presence in a cohort of incident hemodialysis (HD) patients in Greece and (ii) to report on current practices in the management of these patients. This is a prospective, cross-sectional, multicenter study of 574 patients on a regular HD program for >6 months...
October 2011: Artificial Organs
Mikhael F El-Chami, Patrick Kilgo, Vinod Thourani, Omar M Lattouf, David B Delurgio, Robert A Guyton, Angel R Leon, John D Puskas
OBJECTIVES: We sought to investigate the association between new-onset atrial fibrillation after coronary artery bypass graft (CABG) (post-operative atrial fibrillation [POAF]) and long-term mortality in patients with no history of atrial fibrillation. BACKGROUND: POAF predicts longer hospital stay and greater post-operative mortality. METHODS: A total of 16,169 consecutive patients with no history of AF who underwent isolated CABG at our institution between January 1, 1996, and December 31, 2007, were included in the study...
March 30, 2010: Journal of the American College of Cardiology
Holger Reinecke, Eva Brand, Rolf Mesters, Wolf-Rüdiger Schäbitz, Marc Fisher, Hermann Pavenstädt, Günter Breithardt
Patients with chronic kidney disease (CKD) have an increased risk for cardiovascular morbidity and mortality. Little attention has been paid to the problem of atrial fibrillation, although this arrhythmia is very frequent with a prevalence of 13 to 27% in patients on long-term hemodialysis. Because of the large number of pathophysiologic mechanisms involved, these patients have a high risk for both thromboembolic events and hemorrhagic complications. Stroke is a frequent complication in CKD: The US Renal Data System reports an incidence of 15...
April 2009: Journal of the American Society of Nephrology: JASN
Brian Markoff, Alison Amsterdam
Obesity is increasing at an alarming rate worldwide and is a risk factor for cardiac disease, diabetes, and stroke. This provides a challenge for the physicians caring for this patient population in the hospital. Skin integrity, medication dosing, testing, and nutrition are all altered by obesity. We summarize some of the current data on caring for the obese inpatient. Unfortunately, few data on this unique inpatient population exist.
October 2008: Mount Sinai Journal of Medicine, New York
Sami L Khella
Patients with chronic kidney disease (CKD) are predisposed to stroke, especially as the estimated glomerular filtration rate decreases. This update reviews the pathologic mechanisms particular to this stroke population. The treatment for primary and secondary prevention of stroke is reviewed with respect to antiplatelet agents, anticoagulants, surgery, and carotid stenting. The control of chronic hypertension is particularly important in reducing stroke risk in CKD. In patients with prior stroke from atherosclerosis, antiplatelet agents are most beneficial in reducing secondary stroke risk...
October 2008: Advances in Chronic Kidney Disease
Scott E Woods, J Michael Smith, Amy Engle
The objective of the present study was to assess the risk factors for stroke in patients undergoing coronary artery bypass grafting (CABG) surgery. We conducted a nested case-control study from a 9-year, prospective hospitalization cohort (n = 6245). Inclusion in the cohort included CABG between October 1993 and June 2002. Exclusion criteria included any other simultaneously performed surgery. Cases were defined as patients who underwent CABG and experienced a stroke (171 cases, 2.7% of the total), and controls were patients who underwent CABG without a stroke...
July 2004: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Damir Puskar, Josip Pasini, Ivan Savić, Goran Bedalov, Zdenko Sonicki
AIM: To assess the survival of the primary arteriovenous fistula created for dialysis in 463 chronic hemodialysis patients, because the main causes of morbidity among such patients are associated with vascular access-related complications. METHOD: We analyzed 269 (58%) men and 194 (42%) women with median age of 58 years (range 12-83), who underwent 0-14,784 (median 1,584) hours of hemodialysis. Data analyzed were age, gender, body weight loss during hemodialysis session, smoking habits, cause of renal failure, diabetes, myocardial infarction, stroke, malignant neoplasm, arterial hypertension or hypotension, drugs (salicylates, dipyridamole, coumarin anticoagulants, heparin, oral antidiabetics, insulin), number of hemodialysis sessions and hours of hemodialysis per week, fistula location, platelet count, hematocrit, institution in which the fistula had been created, and dialysis center where the fistula had been used...
June 2002: Croatian Medical Journal
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