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Warfarin and dialysis

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https://www.readbyqxmd.com/read/29643259/cerebrovascular-accidents-during-mechanical-circulatory-support-new-predictors-of-ischemic-and-hemorrhagic-strokes-and-outcome
#1
Saef Izzy, Daniel B Rubin, Firas S Ahmed, Feras Akbik, Simone Renault, Katelyn W Sylvester, Henrikas Vaitkevicius, Jennifer A Smallwood, Michael M Givertz, Steven K Feske
BACKGROUND AND PURPOSE: Left ventricular assist devices (LVADs) have emerged as an effective treatment for patients with advanced heart failure refractory to medical therapy. Post-LVAD strokes are an important cause of morbidity and reduced quality of life. Data on risks that distinguish between ischemic and hemorrhagic post-LVAD strokes are limited. The aim of this study was to determine the incidence of post-LVAD ischemic and hemorrhagic strokes, their association with stroke risk factors, and their effect on mortality...
April 11, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29594982/penile-calciphylaxis-in-a-patient-on-combined-peritoneal-dialysis-and-hemodialysis
#2
Takahiro Kasai, Naoki Washida, Hirokazu Muraoka, Kentarou Fujii, Kiyotaka Uchiyama, Keisuke Shinozuka, Kohkichi Morimoto, Hirobumi Tokuyama, Shu Wakino, Hiroshi Itoh
Calciphylaxis presents with painful purpura and intractable skin ulcers on the trunk and particularly the distal extremities, and it mainly occurs in patients on chronic dialysis. A 66-year-old man with renal failure due to diabetic nephropathy was on peritoneal dialysis alone for 1 year, followed by peritoneal dialysis combined with hemodialysis for 3 years. He developed calciphylaxis of the penis, which was diagnosed from the skin biopsy findings and clinical observation. To treat this condition, PD was stopped and HD was performed three times a week...
March 28, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29578207/use-of-oral-anticoagulants-in-patients-with-atrial-fibrillation-and-renal-dysfunction
#3
REVIEW
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...
March 26, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29577340/safety-and-efficacy-of-apixaban-versus-warfarin-in-patients-with-end-stage-renal-disease-meta-analysis
#4
Ronpichai Chokesuwattanaskul, Charat Thongprayoon, Tanyanan Tanawuttiwat, Wisit Kaewput, Pavida Pachariyanon, Wisit Cheungpasitporn
BACKGROUND: At the present, apixaban is the only non-vitamin K oral anticoagulant (NOAC) approved by the FDA for use with patients with creatinine clearance < 15 mL/min or end-stage renal disease (ESRD). However, the recommendations are based on pharmacokinetic and pharmacodynamic data and there was lack of clinical trial evidence. We aimed to assess safety and efficacy of apixaban in patients with advanced chronic kidney disease (CKD) or ESRD. METHODS: Databases were searched through November 2017...
March 25, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29509922/a-systematic-review-of-direct-oral-anticoagulant-use-in-chronic-kidney-disease-and-dialysis-patients-with-atrial-fibrillation
#5
Jordanne Feldberg, Param Patel, Ashley Farrell, Sylvia Sivarajahkumar, Karen Cameron, Jennifer Ma, Marisa Battistella
Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017...
March 2, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29463509/ventricular-fibrillation-conversion-testing-after-implantation-of-a-subcutaneous-implantable-cardioverter-defibrillator-a-report-from-the-national-cardiovascular-data-registry
#6
Daniel J Friedman, Craig S Parzynski, E Kevin Heist, Andrea M Russo, Joseph G Akar, James V Freeman, Jeptha P Curtis, Sana M Al-Khatib
Background -Compared to transvenous (TV) implantable cardioverter defibrillators (ICD), subcutaneous (S) ICDs require a higher energy for effective defibrillation. Although ventricular fibrillation (VF) conversion testing (CT) is recommended after S-ICD implantation to ensure an adequate margin between the defibrillation threshold and maximum device output (80J), prior work found that adherence to this recommendation is declining. Methods -We studied first time S-ICD recipients (between September 28, 2012 and April 1, 2016) in the National Cardiovascular Database Registry ICD Registry to determine: predictors of use of CT, predictors of an insufficient safety margin (ISM, defined as VF conversion energy >65J) during testing, and in-hospital outcomes associated with use of CT...
February 20, 2018: Circulation
https://www.readbyqxmd.com/read/29421806/taking-warfarin-with-heparin-replacement-and-direct-oral-anticoagulant-is-a-risk-factor-for-bleeding-after-endoscopic-submucosal-dissection-for-early-gastric-cancer
#7
Yoji Sanomura, Shiro Oka, Shinji Tanaka, Naoki Yorita, Kazutaka Kuroki, Mio Kurihara, Takeshi Mizumoto, Yoshikazu Yoshifuku, Kazuaki Chayama
BACKGROUND: Although bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains problematic, especially in patients taking anticoagulants, there are differing views on the ideal and optimal management for these patients. This study investigated the risk of bleeding after ESD in patients taking anticoagulants. METHODS: We enrolled 61 consecutive patients taking anticoagulants (anticoagulant group) and 968 patients taking no antithrombotic agents (non-antithrombotic group) treated with ESD for EGC between December 2010 and October 2016...
February 8, 2018: Digestion
https://www.readbyqxmd.com/read/29219209/warfarin-use-and-the-risk-of-stroke-bleeding-and-mortality-in-older-adults-on-dialysis-with-incident-atrial-fibrillation
#8
Jingwen Tan, Sunjae Bae, Jodi B Segal, Junya Zhu, G Caleb Alexander, Dorry L Segev, Mara McAdams-DeMarco
AIM: There is conflicting evidence regarding the safety and effectiveness of warfarin for atrial fibrillation (AF) treatment among older end-stage renal disease (ESRD) patients, and differences among subgroups are unclear. METHODS: Older dialysis patients who were newly diagnosed with AF (7/2007-12/2011) were identified in the United States Renal Data System. The adjusted hazard ratios (HR) of the outcomes (any stroke, ischemic stroke, major bleeding, severe gastrointestinal bleeding, and death) by time-varying warfarin use were estimated using Cox regression accounting for the inverse probability of treatment weight...
December 8, 2017: Nephrology
https://www.readbyqxmd.com/read/29207361/patient-factors-but-not-the-use-of-novel-anticoagulants-or-warfarin-are-associated-with-internal-jugular-vein-access-site-hematoma-after-right-heart-catheterization
#9
Osama Dasa, Qaiser Shafiq, Mohammed Ruzieh, Luai Alhazmi, Maen Al-Dabbas, Zaid Ammari, Samer Khouri, George Moukarbel
INTRODUCTION: Right heart catheterization (RHC) is routinely performed to assess hemodynamics. Generally, anticoagulants are held prior to the procedure. At our center, anticoagulants are continued and ultrasound guidance is always used for internal jugular vein access. A micropuncture access kit is used to place a 5 or 6 Fr sheath using the modified Seldinger technique. Manual compression is applied for 10-15 min and the patient is observed for at least 2 hours after the procedure. In a retrospective analysis, we investigated the risk of bleeding complications associated with RHC via the internal jugular vein in patients with and without full anticoagulation...
December 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/29193545/identification-and-characterization-of-a-single-high-affinity-fatty-acid-binding-site-in-human-serum-albumin
#10
Lea Wenskowsky, Herman Schreuder, Volker Derdau, Hans Matter, Julia Volkmar, Marc Nazaré, Till Opatz, Stefan Petry
A single high-affinity fatty acid binding site in the important human transport protein serum albumin (HSA) is identified and characterized using an NBD (7-nitrobenz-2-oxa-1,3-diazol-4-yl)-C12 fatty acid. This ligand exhibits a 1:1 binding stoichiometry in its HSA complex with high site-specificity. The complex dissociation constant is determined by titration experiments as well as radioactive equilibrium dialysis. Competition experiments with the known HSA-binding drugs warfarin and ibuprofen confirm the new binding site to be different from Sudlow-sites I and II...
January 22, 2018: Angewandte Chemie
https://www.readbyqxmd.com/read/29147170/clinical-assessment-of-warfarin-therapy-in-patients-with-maintenance-dialysis-clinical-efficacy-risks-and-development-of-calciphylaxis
#11
Hajime Hasegawa
Recent years, multiple studies regarding clinical efficacy and risks of Warfarin therapy in dialysis patients have been reported, and not a few reports conclude that clinical advantage of Warfarin is questionable in dialysis patients. Conversely, its hemorrhagic risk might be a little more serious in dialysis patients comparing to non-dialysis patients. Basically, it is assumed that long-term administration of Warfarin accelerates the development of vascular athelosclerosis because of the abolished anti-calcification effect of Gla-protein activation by decreased vitamin K activity...
September 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29117741/%C3%AE-thromboglobulin-may-not-reflect-platelet-activation-during-haemodialysis-with-the-hepran-membrane
#12
Solbjørg Sagedal, Leiv Sandvik, Olav Klingenberg, Per Morten Sandset
BACKGROUND: When blood passes through the extracorporeal circuit during haemodialysis (HD) undesirable effects including platelet degranulation and coagulation activation take place. β-thromboglobulin (β-TG) is a sensitive marker of platelet activation. The aim of this study was to investigate platelet degranulation and coagulation activation during HD with the heparin-coated dialysis membrane HeprAN. METHODS: Four HD sessions were evaluated in each of 12 chronic HD patients...
December 2017: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/29058165/clinical-characteristics-and-risk-factors-associated-with-mortality-in-calcific-uremic-arteriolopathy
#13
Peter W Santos, Jianghua He, Ahmad Tuffaha, James B Wetmore
BACKGROUND: Calcific uremic arteriolopathy (CUA) is an often-fatal condition in dialysis patients. The clinical descriptions and treatments of CUA patients have been confined mostly to case reports. We report a comprehensive characterization of CUA and its associated diagnosis, treatment patterns, and outcome. METHODS: An internet-based registry collected information about CUA in dialysis patients. Univariate analysis using Cox proportional hazards models estimated hazard ratios of the association between clinical characteristics, laboratory values, and treatments with all-cause mortality...
December 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/29026877/prolonged-delayed-renal-graft-function-secondary-to-venous-hypertension
#14
Suraj Mishra, Gaurav Gupta, I Moinuddin, Brian Strife, Uma Prasad, D Massey, Anne King, Dhiren Kumar, Chandra S Bhati
The case of a 39-year-old highly sensitized woman who underwent second renal transplantation after being on warfarin because of a history of frequent thromboses of her left femoral arteriovenous graft (AVG) is reported here. The patient received a flow cytometric positive crossmatch kidney transplant from a deceased donor. Her posttransplant course was complicated by prolonged delayed graft function (DGF) lasting for 9 months. Antibody-mediated rejection occurred in the immediate postoperative period. This resolved after treatment, and resolution was confirmed by repeat biopsy...
October 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28992319/atrial-fibrillation-in-kidney-transplant-recipients-is-there-a-place-for-the-novel-drugs
#15
Jolanta Malyszko, Paulina Lopatowska, Elzbieta Mlodawska, Dominika Musialowska, Jacek S Malyszko, Anna Tomaszuk-Kazberuk
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia of high clinical importance, occurring in 2% of the general population and in 19-24% in patients with chronic kidney disease. It is a well-known risk factor for cardiovascular morbidity and mortality. Kidney transplant recipients with a history of AF were associated with significantly higher rate of ischaemic strokes, graft failure and post-transplant mortality. AF occurs in over 7% of kidney transplant recipients in the first 3 years after transplantation and is associated with reduced graft and patient survival...
September 7, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28948673/piperine-decreases-binding-of-drugs-to-human-plasma-and-increases-uptake-by-brain-microvascular-endothelial-cells
#16
Raghvendra K Dubey, Brigitte Leeners, Bruno Imthurn, Gabriele Susanne Merki-Feld, Marinella Rosselli
We previously reported that piperine, an active alkaloidal principal of black and long peppers, enhances drug bioavailability by inhibiting drug metabolism. Another mechanism influencing drug availability/uptake is its free fraction. Since piperine is highly lipophilic, we hypothesize that it could also interact with drugs through binding displacement and influence their bioavailability. Accordingly, using equilibrium dialysis, we investigated whether piperine alters the binding of model drug ligands, that is flunitrazepam, diazepam, warfarin, salicylic acid, propranolol, lidocaine, and disopyramide to human plasma (n = 4)...
December 2017: Phytotherapy Research: PTR
https://www.readbyqxmd.com/read/28933798/pharmacokinetics-of-tecarfarin-and-warfarin-in-patients-with-severe-chronic-kidney-disease
#17
Detlef Albrecht, Mintu P Turakhia, Daniel Ries, Thomas Marbury, William Smith, Debbie Dillon, Peter G Milner, Mark G Midei
Chronic kidney disease (CKD) complicates warfarin anticoagulation partially through its effect on CYP2C9 activity. Tecarfarin, a novel vitamin K antagonist, is not metabolized by CYP2C9. To evaluate the effect of CKD on their metabolism, we measured PK parameters of warfarin and tecarfarin in subjects with and without CKD. CKD subjects with estimated glomerular filtration rate < 30 mL/min not on dialysis ( n  = 13) were matched to healthy volunteers (HVs) ( n  = 10). Each subject was randomized to either warfarin 10 mg or tecarfarin 30 mg and was later crossed over to the other drug...
November 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28910806/warfarin-use-and-increased-mortality-in-end-stage-renal-disease
#18
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
https://www.readbyqxmd.com/read/28856671/direct-oral-anticoagulant-medications-in-calciphylaxis
#19
Brian J King, Rokea A El-Azhary, Marian T McEvoy, Raymond C Shields, Robert D McBane, James T McCarthy, Mark D P Davis
BACKGROUND: Recent studies suggest that calciphylaxis is a thrombotic condition in which arteriolar thrombosis leads to painful skin infarcts and consequent morbidity and mortality. Paradoxically, warfarin is implicated as a risk factor for calciphylaxis. Our objective is to report the use of oral direct thrombin and factor Xa inhibitors (termed direct oral anticoagulants [DOACs]) in patients with calciphylaxis. METHODS: We retrospectively reviewed records of 16 patients with calciphylaxis who received concomitant administration of novel anticoagulants...
October 2017: International Journal of Dermatology
https://www.readbyqxmd.com/read/28801476/warfarin-use-in-patients-with-atrial-fibrillation-undergoing-hemodialysis-a-nationwide-population-based-study
#20
Chang-Yun Yoon, Juhwan Noh, Jong Hyun Jhee, Tae Ik Chang, Ea Wha Kang, Youn Kyung Kee, Hyoungnae Kim, Seohyun Park, Hae-Ryong Yun, Su-Young Jung, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Shin-Wook Kang, Changsoo Kim, Tae-Hyun Yoo
BACKGROUND AND PURPOSE: The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. METHODS: Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use...
September 2017: Stroke; a Journal of Cerebral Circulation
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