Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

Kleinow, Megan E.; Garwood, Candice L.; Clemente, Jennifer L.; Whittaker, Peter

doi:10.18553/jmcp.2011.17.7.523

Cited by 57 publications

(37 citation statements)

References 19 publications

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“…51 This conclusion was supported by a significantly higher number of clinic visits for dose change (22% vs. 12%, P < 0.001) and a decreased time between scheduled visits (mean length 16 days vs. 19.7 days, P = 0.001). 51 The major potential complication with any anticoagulant therapy is an increased risk of bleeding, which can be severe and difficult to control. Though ICH and major GI bleeding associated with anticoagulant therapy are rare, they can be costly, with 1-year costs ranging from $7,584 to $193,804.…”

Section: ■■ Discussionmentioning

confidence: 86%

“…Kleinow et al (2011) showed that patients with chronic kidney disease (CKD) required a 24% (mean: 35.9 vs. 47.0 mg per week, P = 0.003) lower dose than the patients without CKD and spent less time in therapeutic range, which increased clinic management versus the comparison group. 51 This conclusion was supported by a significantly higher number of clinic visits for dose change (22% vs. 12%, P < 0.001) and a decreased time between scheduled visits (mean length 16 days vs. 19.7 days, P = 0.001). 51 The major potential complication with any anticoagulant therapy is an increased risk of bleeding, which can be severe and difficult to control.…”

Section: ■■ Discussionmentioning

confidence: 99%

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Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

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In the European Union, 4.5 million people are estimated to have AF.2 Patients with untreated AF are at a 4-to 5-fold increased risk of stroke compared with those without the disease. Vitamin K antagonists (VKAs), such as warfarin, have been successfully used for many years to provide prophylaxis against stroke in patients with AF. A large meta-analysis of randomized trials showed that adjusted-dose warfarin reduced the incidence of stroke by 64%. 4 However, in a real-world analysis of Medicare patients with AF, the reduction in stroke with warfarin was lower than in the meta-analysis, at 27%. 5While effective, VKAs are associated with a number of limitations: they have numerous drug and food interactions; their effect is influenced by genetic factors; and they have a narrow therapeutic range, requiring frequent international normalized ratio (INR) monitoring and dose adjustments.6 As a result of these factors, there is considerable variability in the amount of time patients spend within the therapeutic range (INR, 2.0-3.0), which exposes them to stroke when they are below the range and bleeding when they are above the range.New anticoagulants have been developed to reduce the risk of stroke in patients with AF. These oral agents are direct inhibitors of single coagulation factors and include dabigatran, rivaroxaban, and apixaban.7 They meet the need for predictable anticoagulation with fixed dosing, without the need for laboratory monitoring. As may be expected, these anticoagulants are more expensive per unit than warfarin.7 However, the

show abstract

Section: ■■ Discussionmentioning

confidence: 86%

Section: ■■ Discussionmentioning

confidence: 99%

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

View full text Add to dashboard Cite

show abstract

“…All this can become even more complex in elderly patients with CKD. These patients experience a decrease in anticoagulant stability when taking VKA, and need more frequent monitoring and twice as frequent dose adjustments compared with patients that have normal renal function [43].…”

Section: Discussionmentioning

confidence: 99%

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Corrao

Argano

Nobili

et al. 2015

European Journal of Internal Medicine

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“…[26] Because INR in CKD patients is often labile, such patients require lower doses of warfarin and more frequent testing and dose adjustment. [27] While warfarin effectively reduces stroke risk and is safe in moderate stage 3 CKD (creatinine clearance 30 -60 ml/min), its value is less certain in end-stage renal disease. [28,29] Discontinuing warfarin when commencing treatment with a novel oral anticoagulant When changing to one of the novel oral anticoagulants, warfarin should be withdrawn and the INR monitored daily.…”

Section: Warfarin In Chronic Kidney Diseasementioning

confidence: 99%

Warfarin in non-valvular atrial fibrillation

Dalby

Wessels²,

Opie

2013

S Afr Med J

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Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

Cited by 57 publications

References 19 publications

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Warfarin in non-valvular atrial fibrillation

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