Cohort study on the quality of oral anticoagulation therapy in chronic haemodialysis patients treated with phenprocoumon

Praehauser, Claudia; Grandjean, Renée; Steiger, Juerg; Mayr, Michael

doi:10.4414/smw.2013.13730

Cited by 3 publications

(3 citation statements)

References 54 publications

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“…Conversely, two studies suggested that warfarin use may not significantly increase the risk of bleeding . Nephrologists are therefore faced with concerns about the risk—benefit assessment before prescribing oral anticoagulants and/or additional anticoagulation to prevent clotting during the HD session without additional bleeding complications in such patients .…”

Section: Resultsmentioning

confidence: 99%

Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach

Kessler¹,

Moureau

Nguyên

2015

Seminars in Dialysis

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Appropriate anticoagulation for hemodialysis (HD) requires a subtle balance between under-and over-heparinization to prevent extracorporeal circuit (ECC) clotting and bleeding, respectively. We discuss five key issues relating to anticoagulation therapy for chronic HD in adults following a review of relevant literature published since 2002: (i) options for standardization of anticoagulation in HD settings. The major nephrology societies have issued low evidence level recommendations on this subject. Interventional studies have generally investigated novel lowmolecular weight heparins and provided data on safety of dosing regimens that cannot readily be extrapolated to clinical practice; (ii) identification of clinical and biological parameters to aid individualization of anticoagulation treatment. We find that use of clinical and biological monitoring of anticoagulation during HD sessions is currently not clearly defined in routine clinical practice; (iii) role of ECC elements (dialysis membrane and blood lines), dialysis modalities, and blood flow in clotting development; (iv) options to reduce or suppress systemic heparinization during HD sessions. Alternative strategies have been investigated, especially when the routine mode of anticoagulation was not suitable in patients at high risk of bleeding or was contraindicated; (v) optimization of anticoagulation therapy for the individual patient. We conclude by proposing a standardized approach to deliver anticoagulation treatment for HD based on an individualized prescription prepared according to the patient's profile and needs.Maintaining full patency in the extracorporeal circuit (ECC) during hemodialysis (HD) sessions is a prerequisite for optimal HD quality (1-4). A complex disturbance of the coagulation system is commonly encountered in patients at the terminal stage of chronic kidney disease (CKD), leading to considerable morbidity and mortality (5). Although HD reduces the bleeding risk by the removal of uremic toxins, interaction between blood and artificial surfaces contributes to activate coagulation pathways. This nonphysiological environment leads to clotting on these foreign surfaces which reduces HD efficiency, shortens circuit lifetime, and increases patient blood loss, nursing workload, disposable consumption, and thus the cost of treatment (3,4).Appropriate anticoagulation requires a subtle balance between under-and over-heparinization to prevent ECC clotting and bleeding, respectively. HD patients are prone to prolonged bleeding episodes from dialysis fistula, as well as gastrointestinal and intracranial hemorrhage (5). Conversely, they may develop a prothrombotic status or comorbid conditions requiring oral anticoagulants or antiplatelet agents (1,5). Of interest, the dialysis population represents the only group of patients to receive heparin three times per week, with a potential longterm cumulative effect associated with an increased risk of osteoporosis, aldosterone suppression and hyperkalemia, and a deterioration of lipid profile...

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Section: Resultsmentioning

confidence: 99%

Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach

Kessler¹,

Moureau

Nguyên

2015

Seminars in Dialysis

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“…In a more recent study, the incidence of major hemorrhage for hemodialysis patients treated with and without warfarin was 10.8 and 8.0/100 patient-years, respectively, compared to 2.1/100 patient-years for patients without renal failure treated with warfarin [22]. Patients with ESRD have also been found in some [17,23] but not all studies [25,26] to spend a greater proportion of time outside the therapeutic INR window than patients from the general population. Patients with severe renal failure have been shown to require a lower dose of warfarin [23], which might be related to a relative vitamin K deficiency [24].…”

Section: Risks and Benefits Of Oral Anticoagulantsmentioning

confidence: 97%

Anticoagulant and antiplatelet therapy in patients with chronic kidney disease

Harmon

Zimmerman²,

Zimmerman³

2013

Current Opinion in Nephrology &Amp; Hypertension

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“…In a recent study, Praehause et al [38] analysed the quality of oral phenprocoumon treatment control in ESRD patients, suggested that phenprocoumon is not inferior to warfarin. The phenprocoumon therapeutic effect in HD patients with AF required to further verification.…”

Section: A N U S C R I P Tmentioning

confidence: 98%

Warfarin use and the risks of stroke and bleeding in hemodialysis patients with atrial fibrillation: A systematic review and a meta-analysis

Wang

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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Cohort study on the quality of oral anticoagulation therapy in chronic haemodialysis patients treated with phenprocoumon

Cited by 3 publications

References 54 publications

Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach

Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach

Anticoagulant and antiplatelet therapy in patients with chronic kidney disease

Warfarin use and the risks of stroke and bleeding in hemodialysis patients with atrial fibrillation: A systematic review and a meta-analysis

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