Cautious anticoagulation strategy in patients with dialysis-requiring end-stage kidney disease

To the Editor: We read with interest this manuscript which demonstrated in a large clinical registry that patients with chronic kidney disease with indications for anticoagulation were often treated subtherapeutically.1 A more aggressive approach was, therefore, advocated. We would like to point out that, while this study should be commended for including a large number of patients, it did not show data on the key clinical outcomes of stroke or bleeding. We feel, therefore, that a clear association cannot be made between low time in the therapeutic range (TTR) and any negative clinical outcome. In fact, paradoxically, our experience from a large tertiary cardiac and renal service differs. We agree with the authors that haemodialysis patients often have a suboptimal TTR, but we believe there is no convincing data implying that increased time spent in therapeutic range is beneficial in preventing embolic or thrombotic events.2 In...

Source: Heart - March 28, 2017 Category: Cardiology Authors: Behar, J. M., Forbes, S. H., Wragg, A., Sporton, S. Tags: Correspondence Source Type: research