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Warfarin and dialysis

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https://www.readbyqxmd.com/read/28302754/apixaban-pharmacokinetics-at-steady-state-in-hemodialysis-patients
#1
Thomas A Mavrakanas, Caroline F Samer, Sharon J Nessim, Gershon Frisch, Mark L Lipman
It is unclear whether warfarin is protective or harmful in patients with ESRD and atrial fibrillation. This state of equipoise raises the question of whether alternative anticoagulants may have a therapeutic role. We aimed to determine apixaban pharmacokinetics at steady state in patients on hemodialysis. Seven patients received apixaban 2.5 mg twice daily for 8 days. Blood samples were collected before and after apixaban administration on days 1 and 8 (nondialysis days). Significant accumulation of the drug was observed between days 1 and 8 with the 2...
March 16, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28276631/antithrombotic-medications-in-dialysis-patients-a-double-edged-sword
#2
REVIEW
Georgios Vlachopanos, Farid Girgis Ghalli
In the clinical context of end-stage renal disease (ESRD), thrombosis and bleeding risks are simultaneously increased and may have devastating consequences. While anticoagulant and antiplatelet drugs are indispensable for the prevention of thromboembolic events, the significantly higher bleeding risk makes their handling extremely complicated. In ESRD, they are frequently administered for a wide array of conditions. For example, atrial fibrillation is quite common in ESRD and warrants the use of anticoagulants like warfarin...
November 10, 2016: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/28120282/treatment-of-atrial-fibrillation-with-warfarin-among-older-adults-with-end-stage-renal-disease
#3
Jingwen Tan, Sunjae Bae, Jodi B Segal, Junya Zhu, Dorry L Segev, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. METHODS: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation...
January 24, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28117916/comparison-of-the-safety-and-effectiveness-of-apixaban-versus-warfarin-in-patients-with-severe-renal-impairment
#4
Brooke E Stanton, Naomi S Barasch, Katie B Tellor
STUDY OBJECTIVE: The United States Food and Drug Administration approval of apixaban in patients with a creatinine clearance (CrCl) less than 15 mL/minute or those receiving dialysis is based only on pharmacokinetic data as clinical trials of apixaban excluded patients with a CrCl less than 25 mL/minute or a serum creatinine concentration (SCr) greater than 2.5 mg/dL. Thus, the objective of this study was to evaluate the safety and effectiveness of apixaban versus warfarin in patients with severe renal impairment...
January 24, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28101466/characterization-of-the-effect-of-drug-drug-interaction-on-protein-binding-in-concurrent-administration-of-sulfamethoxazol-and-diclofenac-sodium-using-bovine-serum-albumin
#5
Md Kamal Hossain, Amina Khatun, Mahmudur Rahman, Md Nahid Akter, Sadia Afreen Chowdhury, Sm Mahbubul Alam
Purpose: This project was aimed to determine the effect of concurrent administration of sulfamethoxazole and diclofenac sodium. Methods: Equilibrium dialysis method was adopted to study different protein binding aspects of sulfamethoxazole and diclofenac sodium. Results: Sulfamethoxazole showed two types of association constants; high affinity constant 29.0±0.20×10(6) M(-1) with lower number of binding sites of 0.7±1 and low affinity constant 1.13±0.20×10(6) M(-1) with higher number of binding sites of 3...
December 2016: Advanced Pharmaceutical Bulletin
https://www.readbyqxmd.com/read/28099971/warfarin-associated-nonuremic-calciphylaxis
#6
Wesley Yung-Hsu Yu, Tina Bhutani, Rachel Kornik, Laura B Pincus, Theodora Mauro, Michael D Rosenblum, Lindy P Fox
Importance: Classic calciphylaxis associated with renal failure is a life-threatening disease. Warfarin-associated calciphylaxis without renal injury has been described, but whether it is a subset of classic calciphylaxis or a different entity remains unknown. We describe 1 case of warfarin-associated calciphylaxis, present data from 2 others from our institution, and review all cases of warfarin-associated calciphylaxis available in the literature. Our review indicates that warfarin-associated calciphylaxis is clinically and pathophysiologically distinct from classic calciphylaxis...
March 1, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28049648/vitamin-k-dependent-carboxylation-of-matrix-gla-protein-influences-the-risk-of-calciphylaxis
#7
Sagar U Nigwekar, Donald B Bloch, Rosalynn M Nazarian, Cees Vermeer, Sarah L Booth, Dihua Xu, Ravi I Thadhani, Rajeev Malhotra
Matrix Gla protein (MGP) is a potent inhibitor of vascular calcification. The ability of MGP to inhibit calcification requires the activity of a vitamin K-dependent enzyme, which mediates MGP carboxylation. We investigated how MGP carboxylation influences the risk of calciphylaxis in adult patients receiving dialysis and examined the effects of vitamin K deficiency on MGP carboxylation. Our study included 20 patients receiving hemodialysis with calciphylaxis (cases) and 20 patients receiving hemodialysis without calciphylaxis (controls) matched for age, sex, race, and warfarin use...
January 3, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27998624/warfarin-initiation-atrial-fibrillation-and-kidney-function-%C3%A2-comparative-effectiveness-and-safety-of%C3%A2-warfarin%C3%A2-in%C3%A2-older%C3%A2-adults%C3%A2-with-newly-diagnosed-atrial%C3%A2-fibrillation
#8
Min Jun, Matthew T James, Zhihai Ma, Jianguo Zhang, Marcello Tonelli, Finlay A McAlister, Braden J Manns, Pietro Ravani, Robert R Quinn, Natasha Wiebe, Vlado Perkovic, Stephen B Wilton, Wolfgang C Winkelmayer, Brenda R Hemmelgarn
BACKGROUND: The effectiveness and safety of warfarin use among patients with atrial fibrillation (AF) and reduced kidney function are uncertain. STUDY DESIGN: Community-based retrospective cohort study (May 1, 2003, to March 31, 2012) using province-wide laboratory and administrative data in Alberta, Canada. SETTING & PARTICIPANTS: 14,892 adults 66 years or older with new AF and a measurement of kidney function. Long-term dialysis patients or kidney transplant recipients were excluded...
December 17, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27852694/warfarin-utilisation-and-anticoagulation-control-in-patients-with-atrial-fibrillation-and-chronic-kidney-disease
#9
Felix Yang, Jessica A Hellyer, Claire Than, Aditya J Ullal, Daniel W Kaiser, Paul A Heidenreich, Donald D Hoang, Wolfgang C Winkelmayer, Susan Schmitt, Susan M Frayne, Ciaran S Phibbs, Mintu P Turakhia
OBJECTIVE: To evaluate warfarin prescription, quality of international normalised ratio (INR) monitoring and of INR control in patients with atrial fibrillation (AF) and chronic kidney disease (CKD). METHODS: We performed a retrospective cohort study of patients with newly diagnosed AF in the Veterans Administration (VA) healthcare system. We evaluated anticoagulation prescription, INR monitoring intensity and time in and outside INR therapeutic range (TTR) stratified by CKD...
November 15, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27769175/warfarin-use-and-stroke-bleeding-and-mortality-risk-in-patients-with-end-stage-renal-disease-and-atrial-fibrillation-a-systematic-review-and-meta-analysis
#10
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27734602/recurrent-heparin-induced-thrombocytopenia-due-to-heparin-rinsing-before-priming-the-machine-in-a-hemodialysis-patient-a-case-report
#11
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
October 13, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27698566/calciphylaxis-in-peritoneal-dialysis-patients-a-single-center-cohort-study
#12
Yanchen Zhang, Kristin M Corapi, Maria Luongo, Ravi Thadhani, Sagar U Nigwekar
BACKGROUND: Calciphylaxis is a rare but devastating condition in end-stage renal disease (ESRD) patients. Most research in the field of calciphylaxis is focused on hemodialysis (HD) patients; however, data on calciphylaxis incidence, risk factors, and mortality in peritoneal dialysis (PD) patients are limited. METHODS: In this cohort study, we examined data from adult patients who initiated PD for ESRD management at our institute's PD unit from January 2001 to December 2015...
2016: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/27636771/cardiovascular-complications-in-chronic-dialysis-patients
#13
Thomas A Mavrakanas, David M Charytan
PURPOSE OF REVIEW: This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS: Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death...
November 2016: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27598317/patients-characteristics-affect-the-survival-benefit-of-warfarin-treatment-for-hemodialysis-patients-with-atrial-fibrillation-a-historical-cohort-study
#14
Diego Brancaccio, Luca Neri, Francesco Bellocchio, Carlo Barbieri, Claudia Amato, Flavio Mari, Bernard Canaud, Stefano Stuard
BACKGROUND: Stroke prevention in dialysis-dependent patients with atrial fibrillation (AF) is an unresolved clinical dilemma. Indeed, no randomized controlled trial evaluating the efficacy and safety of oral anticoagulants in this population, has been conducted so far. Observational research on the use of warfarin in patients on dialysis has shown conflicting results. This uncertainty is mirrored by the wide variations in warfarin prescription patterns across centers. We sought to evaluate the association between the use of vitamin K antagonists (VKAs) and mortality among hemodialysis patient with AF and to assess potential factors affecting the risk-benefit profile of warfarin in this population...
2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27472258/atrial-fibrillation-and-chronic-kidney-disease-requiring-hemodialysis-does-warfarin-therapy-improve-the-risks-of-this-lethal-combination
#15
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
https://www.readbyqxmd.com/read/27470252/the-risk-of-bleeding-with-tunneled-dialysis-catheter-placement
#16
Gerald A Beathard, Aris Urbanes, Terry Litchfield
PURPOSE: The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications. METHODS: Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held...
September 21, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27416028/risk-of-cerebral-infarction-in-japanese-hemodialysis-patients-miyazaki-dialysis-cohort-study-mid-study
#17
Tatsunori Toida, Yuji Sato, Hideto Nakagawa, Hiroyuki Komatsu, Shigehiro Uezono, Kazuhiro Yamada, Tabito Ishihara, Shuichi Hisanaga, Kazuo Kitamura, Shouichi Fujimoto
BACKGROUND/AIMS: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI) events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients. METHODS: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range), 69.0 (59.0-78.0) years; 41.5% female) were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years...
2016: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/27386140/efficacy-and-safety-of-warfarin-in-dialysis-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#18
Surapon Nochaiwong, Chidchanok Ruengorn, Rattanaporn Awiphan, Phongsak Dandecha, Kajohnsak Noppakun, Arintaya Phrommintikul
OBJECTIVE: To systematically review and meta-analyse the risk-benefit ratio of warfarin users compared with non-warfarin users in patients with atrial fibrillation (AF), who are undergoing dialysis. METHODS: We searched PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, grey literature, conference proceedings, trial registrations and also did handsearch. Cohort studies without language restrictions were included. Two investigators independently conducted a full abstraction of data, risk of bias and graded evidence...
2016: Open Heart
https://www.readbyqxmd.com/read/27312761/outpatient-removal-of-tunneled-dialysis-catheters-by-nephrology-fellows-in-training-at-a-veterans-affairs-medical-center
#19
Neville R Dossabhoy, Bhupinder Sangha, Mihály B Tapolyai, Tibor Fülöp
BACKGROUND: Removal of tunneled dialysis catheters (TDC) usually occurs in dedicated procedure suites and is performed relatively rarely at the bedside. Scarce evidence exists in the literature to assess the safety and success of this procedure when performed during supervised academic training. PATIENTS AND METHODS: We conducted a retrospective chart review of all TDC removals performed on an outpatient basis by nephrology fellows under faculty supervision during a 5-year period at an academic Veterans Affairs Medical Center...
July 12, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27311528/nonvitamin-k-anticoagulant-agents-in%C3%A2-patients-with-advanced-chronic-kidney%C3%A2-disease-or-on-dialysis-with-af
#20
REVIEW
Kevin E Chan, Robert P Giugliano, Manesh R Patel, Stuart Abramson, Meg Jardine, Sophia Zhao, Vlado Perkovic, Franklin W Maddux, Jonathan P Piccini
Nonvitamin K-dependent oral anticoagulant agents (NOACs) are currently recommended for patients with atrial fibrillation at risk for stroke. As a group, NOACs significantly reduce stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with warfarin. All NOACs are dependent on the kidney for elimination, such that patients with creatinine clearance <25 ml/min were excluded from all the pivotal phase 3 NOAC trials. It therefore remains unclear how or if NOACs should be prescribed to patients with advanced chronic kidney disease and those on dialysis...
June 21, 2016: Journal of the American College of Cardiology
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