Vitamin K antagonists: beyond bleeding.

Abstract

Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinical routine, yet they deserve special consideration in dialysis patients and should influence the decision of whether or not to prescribe vitamin K antagonists in cases lacking clear guidelines. Issues to be taken into consideration in HD patients are the induction or acceleration of cardiovascular calcifications, a 10-fold increased risk of calciphylaxis and problems related to maintaining a target INR range. New anticoagulants like direct thrombin inhibitors are promising but have not yet been approved for ESRD patients. Here, we summarize the nontraditional side effects of coumarins and give recommendations about the use of vitamin K antagonists in ESRD patients.

• Authors: Thilo Krüger, Jürgen Floege
• Journal: Seminars in dialysis (Semin Dial) 2014 Jan-Feb Vol. 27 Issue 1 Pg. 37-41 ISSN: 1525-139X [Electronic] United States
• PMID: 24400802 (Publication Type: Journal Article, Review)
• Copyright: © 2014 Wiley Periodicals, Inc.

Chemical References

• Anticoagulants
• Vitamin K

Topics

• Anticoagulants (administration & dosage, adverse effects)
• Atrial Fibrillation (complications, drug therapy)
• Dose-Response Relationship, Drug
• Drug Monitoring
• Hemorrhage (chemically induced)
• Humans
• International Normalized Ratio
• Kidney Failure, Chronic (complications)
• Renal Insufficiency, Chronic (complications)
• Vascular Calcification
• Venous Thromboembolism (prevention & control)
• Vitamin K (antagonists & inhibitors)