Caution Urged Regarding Warfarin Use

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PHOENIX—The benefits of warfarin should be weighed against potential complications when used to treat atrial fibrillation (AF) in hemodialysis (HD) patients, according to British researchers.

Investigators at Royal Berkshire Hospital in Reading, Berkshire UK, identified 445 patients starting maintenance HD between January 2005 and December 2009. Confirmed AF developed in 48 (10.8%), of whom 20 (43.5%) started treatment with warfarin and 26 (56.5%) received aspirin 75 mg daily.

Two patients who refused either treatment were excluded from analysis. The mean of age of patients in both treatment arms was 74 years. Warfarin was stopped in five patients (25%) because of hemorrhage and stopped in four patients (20%) to avoid hemorrhage, lead researcher Naik Ramesh, FRCP, reported at the 31st Annual Dialysis Conference. None of the aspirin recipients discontinued treatment. Thrombotic stroke occurred in four patients in the aspirin group (15.4%) and two in the warfarin group (10%).

“Warfarin therapy for AF in HD patients resulted in a high incidence of hemorrhage compared with aspirin and needs to be used with caution in this group of patients,” Dr. Ramesh said.

He also noted: “Aspirin therapy is safer with less risk of bleeding or need to discontinue treatment.”

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