Warfarin anticoagulation in hemodialysis patients with atrial fibrillation: comparison of nephrologist-led and anticoagulation clinic-led management

被引:9
作者
Bahbahani, Hamad [1 ]
AlTurki, Ahmed [2 ,3 ]
Dawas, Ahmed [4 ]
Lipman, Mark L. [5 ]
机构
[1] McGill Univ, Hlth Ctr, Dept Med, Div Nephrol, Montreal, PQ, Canada
[2] McGill Univ, Hlth Ctr, Dept Med, Div Internal Med, Montreal, PQ, Canada
[3] McGill Univ, Hlth Ctr, Dept Med, Div Cardiol, Montreal, PQ, Canada
[4] McGill Univ, Fac Med, Montreal, PQ, Canada
[5] Jewish Gen Hosp, Dept Med, Div Nephrol, Montreal, PQ, Canada
关键词
Hemodialysis; Atrial fibrillation; Warfarin; Time in therapeutic range; International normalized ratio (INR); CHRONIC KIDNEY-DISEASE; THERAPY; OUTCOMES; STROKE; INTENSITY; BENEFIT; UPDATE;
D O I
10.1186/s12882-017-0809-x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: There is conflicting evidence of benefit versus harm for warfarin anticoagulation in hemodialysis patients with atrial fibrillation. This equipoise may be explained by suboptimal Time in Therapeutic Range (TTR), which correlates well with thromboembolic and bleeding complications. This study aimed to compare nephrologist-led management of warfarin therapy versus that led by specialized anticoagulation clinic. Methods: In a retrospective cohort of chronic hemodialysis patients from two institutions (Institution A: Nephrologist-led warfarin management, Institution B: Anticoagulation clinic-led warfarin management), we identified patients with atrial fibrillation who were receiving warfarin for thromboembolic prophylaxis. Mean TTRs, proportion of patients achieving TTR = 60%, and frequency of INR testing were compared using a logistic regression model. Results: In Institution A, 16.7% of hemodialysis patients had atrial fibrillation, of whom 36.8% were on warfarin. In Institution B, 18% of hemodialysis patients had atrial fibrillation, and 55.5% were on warfarin. The mean TTR was 61.8% (SD 14.5) in Institution A, and 60.5% (SD 15.8) in Institution B (p-value 0.95). However, the proportion of patients achieving TTR >= 60% was 65% versus 43.3% (Adjusted OR 2.22, CI 0.65-7.63) and mean frequency of INR testing was every 6 days versus every 13.9 days in Institutions A and B respectively. Conclusions: There was no statistical difference in mean TTR between nephrologist-led management of warfarin and that of clinic-led management. However, the former achieved a trend toward a higher proportion of patients with optimal TTR. This improved therapeutic results was associated with more frequent INR monitoring.
引用
收藏
页数:7
相关论文
共 50 条
  • [21] Quality of anticoagulation monitoring in nonvalvular atrial fibrillation patients: Comparison of anticoagulation clinic versus usual care
    Nichol, Michael B.
    Knight, Tara K.
    Dow, Tom
    Wygant, Gail
    Borok, Gerald
    Hauch, Ole
    O'Connor, Richard
    ANNALS OF PHARMACOTHERAPY, 2008, 42 (01) : 62 - 70
  • [22] Warfarin doses for anticoagulation therapy in elderly patients with chronic atrial fibrillation
    Mansur, Antonio de Padua
    Takada, Julio Yoshio
    Avakian, Solange Desiree
    Strunz, Celia M. C.
    CLINICS, 2012, 67 (06) : 543 - 546
  • [23] Warfarin anticoagulation and outcomes in patients with atrial fibrillation - A systematic review and metaanalysis
    Reynolds, MW
    Fahrbach, K
    Hauch, O
    Wygant, G
    Estok, R
    Cella, C
    Nalysnyk, L
    CHEST, 2004, 126 (06) : 1938 - 1945
  • [24] Effects of Combination Therapy With Warfarin and Bucolome for Anticoagulation in Patients With Atrial Fibrillation
    Obata, Hiroaki
    Watanabe, Hiroshi
    Ito, Masahiro
    Hirono, Satoru
    Hanawa, Haruo
    Kodama, Makoto
    Aizawa, Yoshifusa
    CIRCULATION JOURNAL, 2011, 75 (01) : 201 - 203
  • [25] Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management
    Boriani, Giuseppe
    Lee, Geraldine
    Parrini, Iris
    Lopez-Fernandez, Teresa
    Lyon, Alexander R.
    Suter, Thomas
    Van der Meer, Peter
    Cardinale, Daniela
    Lancellotti, Patrizio
    Zamorano, Jose Luis
    Bax, Jeroen J.
    Asteggiano, Riccardo
    EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 2021, 28 (06) : 611 - 621
  • [26] Should Oral Anticoagulation Be Used in ESKD Patients on Hemodialysis with Atrial Fibrillation?: CON
    Lidgard, Benjamin
    Bansal, Nisha
    KIDNEY360, 2021, 2 (09): : 1409 - 1411
  • [27] Knowledge of guidelines for anticoagulation management of patients with atrial fibrillation
    Marcus Wiemer
    T. Kottmann
    M. Starrach
    D. Horstkotte
    G. Nölker
    Herzschrittmachertherapie + Elektrophysiologie, 2015, 26 (2) : 141 - 147
  • [28] Quality of Anticoagulation with Warfarin in Korean Patients with Atrial Fibrillation and Prior Stroke: A Multicenter Retrospective Observational Study
    Hong, Keun-Sik
    Kim, Yang-Ki
    Bae, Hee-Joon
    Nam, Hyo Suk
    Kwon, Sun U.
    Bang, Oh Young
    Cha, Jae-Kwan
    Yoon, Byung-Woo
    Rha, Joung-Ho
    Lee, Byung-Chul
    Park, Jong-Moo
    Park, Man-Seok
    Lee, Jun
    Choi, Jay Chol
    Kim, Dong Eog
    Lee, Kyung Bok
    Park, Tai Hwan
    Lee, Ji Sung
    Kims, Seong-Eun
    Lee, Juneyoung
    JOURNAL OF CLINICAL NEUROLOGY, 2017, 13 (03): : 273 - 280
  • [29] Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist’s perspective
    Maura Ravera
    Elisabetta Bussalino
    Maria Fusaro
    Luca Di Lullo
    Filippo Aucella
    Ernesto Paoletti
    Journal of Nephrology, 2020, 33 : 483 - 495
  • [30] Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist's perspective
    Ravera, Maura
    Bussalino, Elisabetta
    Fusaro, Maria
    Di Lullo, Luca
    Aucella, Filippo
    Paoletti, Ernesto
    JOURNAL OF NEPHROLOGY, 2020, 33 (03) : 483 - 495