Sp559effectiveness and Safety of Warfarin Use for Cardiac Indications in Hemodialysis Patients

Chaaban, A.; Gebran, Nicole; Abdelmegid, Kareem; Abouchacra, Samra; Soliman, K.N.; Agha, Lina; Butt, Saira; Budruddin, M.; Jack, H. El; Saxena, Anail; Bernieh, Bassam; Boobes, Y.; Hakim, M. Al; Hussain, Qutaiba; Ahmed, Ahmed; Khan, Irfan Hussain

doi:10.1093/ndt/gfv197.26

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, renal failure causes downregulation of enzymatic activity and can therefore still alter the pharmacokinetic profile of warfarin (Limdi et al, 2010). This may partly explain the poor INR control seen in patients with severe renal failure on warfarin (Chaaban et al, 2015;Kai et al, 2017;Yang et al, 2017), providing additional evidence against the use of VKAs in this setting. Furthermore, alongside the evidence of inferiority to LMWH, meta-analysis of studies comparing DOACs to VKAs has shown fewer haemorrhagic complications with DOACs in patients with moderate renal impairment (CrCl 30-50 ml/min) (van Es et al, 2014).…”

Section: Renal Diseasementioning

confidence: 99%

Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations

et al. 2018

View full text Add to dashboard Cite

Summary Multiple myeloma is associated with a significant risk of venous thromboembolism (VTE), causing substantial levels of morbidity and mortality. The thrombogenicity of myeloma is multifactorial, with disease‐ and treatment‐related factors playing important roles. Immunomodulatory drugs (IMiDs) and high‐dose dexamethasone, in particular, are known to enhance the thrombotic potential of myeloma. For this reason, assessment of the VTE risk has long been advocated prior to treatment initiation in patients with myeloma requiring IMiD‐based regimens. However, despite routine use of thromboprophylaxis, these patients can still develop VTE and its sequelae. The optimum choice and dose of thromboprophylactic drug is not entirely clear, and with this, there is growing interest regarding use of the direct oral anticoagulants in this setting. In this review we discuss the pathogenesis of thrombosis in multiple myeloma, its relation to some of the commonly used chemotherapeutic regimens, current risk stratification and the evidence supporting the different anticoagulants used as thromboprophylaxis. We propose an amended risk stratification, and consider management of challenging patients, including those with renal impairment and recurrent thrombosis.

show abstract

Section: Renal Diseasementioning

confidence: 99%

Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Este estudio encontró que el TRT era 48.8%, lo que significa que en más de la mitad del tiempo los pacientes se encontraban por fuera del objetivo. Esta falta de meta está bien descrita en la literatura como por Chaaban et al (2015), quienes presentaron datos sobre el uso de warfarina en pacientes en hemodiálisis (HD) versus aquellos con función renal normal y encontró que no sólo los pacientes en HD presentaban más hemorragias, sino que el INR estaba en rango terapéutico solo durante el 25% del tiempo para este grupo (39). Yang et al, (2017), recientemente publicó su estudio donde encontró que solo 21% de los pacientes en diálisis tenían un TRT mayor a 60%; además que durante el 30% del tiempo el INR estaba notablemente fuera de rango (INR menor de 1.5 o mayor de 3.…”

Section: Discussionunclassified

Seguridad de los anticoagulantes orales en enfermedad renal crónica avanzada

Barrada

Bustamante-Trespalacios²,

Castro-Sanchez

et al. 2021

Acta Med Col

View full text Add to dashboard Cite

Antecedentes: los pacientes que toman anticoagulantes orales a largo plazo y además cursan con enfermedad renal crónica (ERC), tienen mayor probabilidad de tener sangrados. Métodos: estudio de cohorte descriptivo retrospectivo en el cual se revisaron historias clínicas de pacientes anticoagulados y con ERC 3 en adelante, atendidos en una clínica de anticoagulación con el fin de evaluar eventos hemorrágicos y características basales de la población en un periodo de dos años Resultados: se incluyeron 238 pacientes. Los anticoagulantes usados fueron warfarina (45%), rivaroxabán (31.5%), apixabán (14.3%) y dabigatrán (3.4%). Según la clasificación KDIGO 78% de los pacientes tenían ERC G3 (37.3% G3a y 40.7% G3b), 15.9% G4 y 5.8% G5 con terapia de reemplazo renal (TRR). En el periodo de estudio solo 20 pacientes (8.4%) tuvieron eventos hemorrágicos, de estos, 7 (35%) fueron mayores (cuatro asociados a warfarina, dos rivaroxabán y uno apixabán). Los otros 13 sangrados fueron menores y asociados a warfarina en 46.1% de los casos. El sangrado digestivo fue el más frecuente (35%), seguido por tejidos blandos (30%). Sólo hubo un sangrado fatal el cual se dio en sistema nervioso central (SNC) en un paciente con ERC G4. Conclusión: se apreció una baja tasa de sangrado, lo que podría estar relacionado con el estrecho seguimiento de una clínica de anticoagulación. El anticoagulante que más frecuentemente se asoció con sangrado fue warfarina, lo cual puede estar relacionado con un bajo tiempo en rango terapéutico (48.8%). Por la baja tasa de eventos, no fue posible la realización de comparaciones.

show abstract

“…Chaaban et al () presented some data on warfarin use in haemodialysis versus normal renal function. The haemodialysis arm had more bleeding (most were on aspirin and warfarin) with a reduced incidence of stroke.…”

Section: Time In Therapeutic Range and Esrdmentioning

confidence: 99%

“…The haemodialysis arm had more bleeding (most were on aspirin and warfarin) with a reduced incidence of stroke. INR was only in range for 25% of the time for the haemodialysis group but 96% of the time for those with normal function (Chaaban et al , ). A study looking at 46 haemodialysis patients and their weekly INRs over the period of 1 year found that the mean TTR was 44%.…”

Section: Time In Therapeutic Range and Esrdmentioning

confidence: 99%

Is anticoagulating haemodialysis patients with non‐valvular atrial fibrillation too risky?

Parker

Mitra²,

Thachil

2018

Br J Haematol

View full text Add to dashboard Cite

There is an increasing understanding of the risks from atrial fibrillation (AF) in the current era. In patients with end-stage renal disease (ESRD) on dialysis, the prevalence of AF is significantly higher compared to the general population and those with earlier stages of CKD. Although anticoagulation of these patients may seem appropriate, there is a lack of conclusive evidence that it provides the same protection from thromboembolic complications as it does in patients not on dialysis. In addition, the increased risk of bleeding in patients requiring dialysis makes the use of anticoagulants less favourable. This article aims to discuss the problem of AF in dialysis patients, summarise the current evidence around the use of oral anticoagulants for AF in ESRD and provide some practical suggestions on management of AF in the haemodialysis population.

show abstract

Sp559effectiveness and Safety of Warfarin Use for Cardiac Indications in Hemodialysis Patients

Cited by 3 publications

References 0 publications

Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations

Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations

Seguridad de los anticoagulantes orales en enfermedad renal crónica avanzada

Is anticoagulating haemodialysis patients with non‐valvular atrial fibrillation too risky?

Contact Info

Product

Resources

About