Warfarin use in hemodialysis patients with atrial fibrillation: decisions based on uncertainty

BMC Nephrology

Louise Moist⁴  Peter G Blake⁴  Catherine M Clase³  Charmaine E Lok¹  Benjamin KA Thomson⁴  Salina Juma² 

[1] Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada;Kidney Clinical Research Unit, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada;Department of Clinical Epidemiology and Statistics, McMaster University, Hamilton, Ontario, Canada;Division of Nephrology, Department of Medicine, London Health Sciences Center, London, Ontario, Canada

关键词: Bleeding;    CKD;    Stroke;    Hemodialysis;    Atrial fibrillation;    Anticoagulation;    Warfarin;   

Others  :  1082865
DOI  :  10.1186/1471-2369-14-174

 received in 2012-08-02, accepted in 2013-07-30,  发布年份 2013

【 摘 要 】

Background

Warfarin prescribing patterns for hemodialysis patients with atrial fibrillation vary widely amongst nephrologists. This may be due to a paucity of guiding evidence, but also due to concerns of increased risks of warfarin use in this population. The literature lacks clarity on the balance of warfarin therapy between prevention of thrombotic strokes and the increased risks of bleeding in hemodialysis patients with atrial fibrillation.

Methods

We performed a survey of Canadian Nephrologists, assessing warfarin prescribing practice, and measured the certainty in making these choices.

Results

Respondents were consistently uncertain about warfarin use for atrial fibrillation. This uncertainty increased with a history of falls or starting hemodialysis, even when a high CHADS2 or CHA2DS2VASc score was present. The majority of respondents agreed that clinical equipoise existed about the use of oral anticoagulation in hemodialysis patients with atrial fibrillation (72.2%) and that the results of a randomized controlled trial would be relevant to their practice (98.2%).

Conclusions

A randomized controlled trial of warfarin use in hemodialysis patients with atrial fibrillation would clarify the risks and benefits of warfarin use in this population.

【 授权许可】

   
2013 Juma et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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