Warfarin Use in End-Stage CDK Patients May Heighten Bleeding Risk

Warfarin Use in End-Stage CDK Patients May Heighten Bleeding Risk

The use of warfarin to treat atrial fibrillation may have an unfavorable risk-benefit ratio in patients with end-stage chronic kidney disease by increasing their risk of significant bleeding, according to findings from a recent meta-analysis published in journal Chest.

Warfarin is an anticoagulant, increasing the time it takes for blood to clot, that works by reducing the effects of vitamin K used in the process of blood-clotting. The drug helps to prevent unwanted clots in people at risk of clot formation because of conditions such as atrial fibrillation. Warfarin is also used to prevent any clots that may have already formed in the blood vessels of the legs, lungs, or heart from becoming larger.

“The current meta-analysis suggests that warfarin use is beneficial in patients with non-end-stage [chronic kidney disease] but may be harmful in patients with end-stage [chronic kidney disease] due to the increased risk of major bleeding,” the researchers wrote, according to a recent news release.

In the study entitled “Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease:A Meta-analysis of Observational Studies,” Khagendra Dahal, MD, clinical assistant professor of medicine at the University of New England LRGHealthcare in Laconia, New Hampshire, and colleagues conducted a database search for observational studies assessing the use of warfarin in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), performing manual searches for relevant references. A total of 13 publications from 11 cohorts were retrieved from the search, including six retrospective and five prospective studies, involving  more than 48, 500 patients and over 11,600 warfarin users.

The results revealed that in patients with AF and non-end-stage CKD, warfarin resulted in a lower risk of mortality and ischemic stroke/thromboembolism, with no effect on major bleeding. In patients with AF and end-stage CKD, warfarin had no effect on mortality and on stroke risk; however, it increased the risk of major bleeding.

“Our meta-analysis provides the most comprehensive review to date on the use of warfarin in patients with CKD,” the researchers wrote. “[An] adequately powered randomized controlled trial should confirm these finding and settle this issue once and for all.”


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