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Warfarin and dialysis

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https://www.readbyqxmd.com/read/27852694/warfarin-utilisation-and-anticoagulation-control-in-patients-with-atrial-fibrillation-and-chronic-kidney-disease
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/27243343/management-of-patients-with-atrial-fibrillation-and-chronic-kidney-disease-in-light-of-the-latest-guidelines
#13
Elżbieta Młodawska, Anna Tomaszuk-Kazberuk, Paulina Łopatowska, Włodzimierz J Musiał, Jolanta Małyszko
Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease...
May 31, 2016: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/27218240/risk-factors-and-outcome-of-stroke-in-renal-transplant-recipients
#14
Mark D Findlay, Peter C Thomson, Rachael MacIsaac, Alan G Jardine, Rajan K Patel, Kathryn K Stevens, Elaine Rutherford, Marc Clancy, Colin C Geddes, Jesse Dawson, Patrick B Mark
Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, and imaging and laboratory variables were assessed and case fatality determined...
August 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27174319/whether-warfarin-therapy-is-associated-with-damage-on-renal-function-in-chinese-patients-with-nonvalvular-atrial-fibrillation
#15
Yu Kong, Xin Du, Ri-Bo Tang, Ting Zhang, Xue-Yuan Guo, Jia-Hui Wu, Shi-Jun Xia, Chang-Sheng Ma
BACKGROUND: Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation (AF). There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF (NVAF). The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy...
May 20, 2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27132702/variation-in-warfarin-use-at-hospital-discharge-after-isolated-bioprosthetic-mitral-valve-replacement-an-analysis-of-the-society-of-thoracic-surgeons-adult-cardiac-surgery-database
#16
Thomas A Schwann, Robert H Habib, Rakesh M Suri, J Matthew Brennan, Xia He, Vinod H Thourani, Milo Engoren, Gorav Ailawadi, Brian R Englum, Mark R Bonnell, James S Gammie
BACKGROUND: Anticoagulation with warfarin following bioprosthetic mitral valve replacement (BMVR) is recommended by multiple practice guidelines. We assessed practice variability and patient characteristics associated with warfarin prescription following BMVR. METHODS: We analyzed 7,637 patients in the Society of Thoracic Surgeons Database (January 1, 2008 to June 30, 2011) who were discharged following isolated primary nonemergent BMVR. Patients requiring preoperative warfarin, those with preoperative atrial fibrillation, or those with a contraindication to warfarin were excluded...
September 2016: Chest
https://www.readbyqxmd.com/read/27103011/mechanism-of-drug-drug-interactions-between-warfarin-and-statins
#17
Abdul Naveed Shaik, Tonika Bohnert, David A Williams, Lawrence L Gan, Barbara W LeDuc
The anticoagulant drug warfarin and the lipid-lowering statin drugs are commonly co-administered to patients with cardiovascular diseases. Clinically significant drug-drug interactions (DDIs) between these drugs have been recognized through case studies for many years, but the biochemical mechanisms causing these interactions have not been explained fully. Previous theories include kinetic alterations in cytochrome P-450-mediated drug metabolism or disturbances of drug-protein binding, leading to anticoagulant activity of warfarin; however, neither the enantioselective effects on warfarin metabolism nor the potential disruption of drug transporter function have been well investigated...
June 2016: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/27080977/a-nationally-representative-study-of-calcific-uremic-arteriolopathy-risk-factors
#18
Sagar U Nigwekar, Sophia Zhao, Julia Wenger, Jeffrey L Hymes, Franklin W Maddux, Ravi I Thadhani, Kevin E Chan
Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060)...
November 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27079417/atrial-fibrillation-in-dialysis-patients-time-to-abandon-warfarin
#19
Diego Brancaccio, Luca Neri, Francesco Bellocchio, Carlo Barbieri, Claudia Amato, Flavio Mari, Bernard Canaud, Stefano Stuard
Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis...
May 16, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27069859/warfarin-skin-necrosis-mimicking-calciphylaxis-in-a-patient-with-secondary-hyperparathyroidism-undergoing-peritoneal-dialysis
#20
Jee Eun Park, Seonggyu Byeon, Hee Kyung Kim, Seong Mi Moon, Ji Hoon Moon, Kee-Taek Jang, Byung-Jae Lee, Hye Ryoun Jang, Wooseong Huh, Dae Joong Kim, Yoon-Goo Kim, Ha Young Oh, Jung Eun Lee
Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation...
March 2016: Kidney Research and Clinical Practice
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