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Warfarin Use, Stroke, and Bleeding Risk among Pre-Existing Atrial Fibrillation US Veterans Transitioning to Dialysis
In this study, we validated risk scores for stroke and bleeding in this population and assessed risk of stroke and bleeding among warfarin users compared to nonusers.Methods: We utilized a cohort of 28,620 pre-dialysis US veterans transitioning to hemodialysis between October 2007 and March 2015. Incident rates for the risks of stroke and bleeding were ascertained based upon CHA2DS2-VASc or HAS-BLED scores, respectively. A propensity score-based competing risk analysis was used to assess risk of stroke and bleeding.Findings: The mean age of our cohort was 77 ± 9 years, and the median CHA2DS2-VASc and HAS-BLED scores were ...
Source: Nephron - February 4, 2022 Category: Urology & Nephrology Source Type: research

Stroke in patients with chronic kidney disease & #8230;: How do we approach and manage it ?
This article is a review of stroke in patients with CKD and approach to managing it.
Source: Indian Journal of Nephrology - May 3, 2017 Category: Urology & Nephrology Authors: S Nayak-Rao MP Shenoy Source Type: research

Impact of atrial fibrillation on the risk of ischemic stroke in patients on hemodialysis: BOREAS-HD3 Study
ConclusionPresent analyses using comprehensive adjustment for multiple confounders, including prior history of ischemic stroke, indicated that AF independently increases the risk of new-onset of ischemic stroke by more than twofold in Japanese HD patients.
Source: Clinical and Experimental Nephrology - November 18, 2020 Category: Urology & Nephrology Source Type: research

Stroke feature and management in dialysis patients.
Abstract Strokes remain the major complication among dialysis population as the number of diabetes and elderly is increasing. In chronic hemodialysis patients, prevalence and incidence of stroke is higher than that of the general population. According to the annual registry data of the Japanese Society for Dialysis Therapy, prevalence of stroke death has been declining, yet the incidence of nonfatal incidence of stroke is not known. Underlying mechanisms of stroke are multiple. Among them, control of hypertension is important for the primary prevention; however, the ideal target level of blood pressure is not dete...
Source: Contributions to Nephrology - May 26, 2013 Category: Urology & Nephrology Authors: Iseki K Tags: Contrib Nephrol Source Type: research

Warfarin Use And the Risk Of Stroke, Bleeding, And Mortality In Older Adults On Dialysis With Incident Atrial Fibrillation
ConclusionOlder ESRD patients with AF who were treated with warfarin had a no difference in stroke risk, lower mortality risk, but increased major bleeding risk. The bleeding risk associated with warfarin was greater among women than men. The risk/benefit ratio of warfarin may be less favorable among older women.
Source: Nephrology - December 1, 2017 Category: Urology & Nephrology Authors: Jingwen Tan, Sunjae Bae, Jodi B. Segal, Junya Zhu, G. Caleb Alexander, Dorry L. Segev, Mara McAdams ‐DeMarco Tags: Original Article Source Type: research

Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation
Conclusions In our population of HD patients with AF, the mortality is very high. OAT is not associated with increased mortality, while antiplatelet drugs are. OAT seems, on the contrary, associated with a better survival; however, it does not decrease the incidence of ischaemic stroke, whereas it increases the incidence of bleeding. Bleeding risk is lower in subjects in whom the INR is kept within the therapeutic range.
Source: Nephrology Dialysis Transplantation - February 23, 2015 Category: Urology & Nephrology Authors: Genovesi, S., Rossi, E., Gallieni, M., Stella, A., Badiali, F., Conte, F., Pasquali, S., Bertoli, S., Ondei, P., Bonforte, G., Pozzi, C., Rebora, P., Valsecchi, M. G., Santoro, A. Tags: Intra- and Extracorporeal Treatments of Kidney Failure Source Type: research

Anticoagulation therapy: Balancing the risks of stroke and bleeding in CKD
Nature Reviews Nephrology 11, 200 (2015). doi:10.1038/nrneph.2015.14 Authors: Arman Qamar & Deepak L. Bhatt Whether anticoagulation with warfarin is safe and reduces risk of stroke in patients with atrial fibrillation and chronic kidney disease is unclear. A recent observational study shows a net clinical benefit of warfarin—without increased risk of bleeding—in this population, including in patients on dialysis.
Source: Nature Reviews Nephrology - February 10, 2015 Category: Urology & Nephrology Authors: Arman QamarDeepak L. Bhatt Tags: News and Views Source Type: research

Direct oral anticoagulants in chronic kidney disease: an update
Purpose of review Direct oral anticoagulants (DOACs) are variably eliminated by the kidneys rendering their use potentially problematic in patients with chronic kidney disease (CKD) or necessitating appropriate dose adjustment. Recent findings Both observational and limited randomized trial data for DOACs compared with no treatment or with warfarin for patients with atrial fibrillation on maintenance dialysis were recently published. In a randomized trial in patients on hemodialysis, there was no significant difference in vascular calcification between patients who received rivaroxaban with or without vitamin K2 or vi...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Use and safety of heparin-free maintenance hemodialysis in the USA
Conclusions Patient markers of increased risk of bleeding and facility region associated with heparin-free HD use. Despite the potential benefits of avoiding heparin use, heparin-free HD was not significantly associated with decreased hazards of death, bleeding or thrombosis, suggesting that it may be no safer than HD with heparin.
Source: Nephrology Dialysis Transplantation - June 18, 2013 Category: Urology & Nephrology Authors: Shen, J. I., Mitani, A. A., Chang, T. I., Winkelmayer, W. C. Tags: Intra- and Extracorporeal Treatment of Kidney Failure Source Type: research

Patients' Characteristics Affect the Survival Benefit of Warfarin Treatment for Hemodialysis Patients with Atrial Fibrillation. A Historical Cohort Study.
CONCLUSION: VKA may provide an early survival benefit; however, this is partially offset later during the follow-up. In addition, heterogeneous risk-benefit profiles were observed among subgroups of dialysis-dependent patients with AF, further emphasizing the complexities of tailoring stroke prevention strategies in this population. PMID: 27598317 [PubMed - as supplied by publisher]
Source: American Journal of Nephrology - September 6, 2016 Category: Urology & Nephrology Authors: Brancaccio D, Neri L, Bellocchio F, Barbieri C, Amato C, Mari F, Canaud B, Stuard S Tags: Am J Nephrol Source Type: research

Atrial fibrillation in dialysis patients: is there a place for non-vitamin K antagonist oral anticoagulants?
AbstractAtrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin. Nevertheless according to ESC guidelines, NOACs are not recommended in p...
Source: International Urology and Nephrology - May 21, 2018 Category: Urology & Nephrology Source Type: research

Atrial Fibrillation in CKD: Balancing the Risks and Benefits of Anticoagulation
Chronic kidney disease (CKD) and atrial fibrillation are common conditions that often coexist and are associated with increased risk of stroke. Despite the wealth of evidence for optimal management of atrial fibrillation in the general population, the role of anticoagulation with warfarin in individuals with CKD with atrial fibrillation is far less well defined. Current recommendations for anticoagulation in patients treated with dialysis and those with an earlier stage of CKD are based on clinical trials in the general atrial fibrillation population that have largely excluded individuals with CKD. Observational studies of...
Source: American Journal of Kidney Diseases - June 7, 2013 Category: Urology & Nephrology Authors: Khai P. Ng, Nicola C. Edwards, Gregory Y.H. Lip, Jonathan N. Townend, Charles J. Ferro Tags: In Practice Source Type: research

Correlates and outcomes of warfarin initiation in kidney transplant recipients newly diagnosed with atrial fibrillation
In the kidney transplant population with atrial fibrillation (AF), evidence regarding the effectiveness and safety of warfarin treatment is lacking. We used fee-for-service Medicare claims to identify kidney transplant recipients with newly diagnosed AF from the United States Renal Data System. Warfarin use within 30 days of AF diagnosis was ascertained from Medicare Part D prescription claims (2007–11) or using a validated algorithm (1997–2011). The study end points were (i) the composite of death, stroke or gastrointestinal bleed, (ii) death and (iii) death-censored graft failure. Warfarin user and non-user g...
Source: Nephrology Dialysis Transplantation - January 28, 2015 Category: Urology & Nephrology Authors: Lenihan, C. R., Montez-Rath, M. E., Shen, J. I., Scandling, J. D., Turakhia, M. P., Chang, T. I., Winkelmayer, W. C. Tags: Renal Transplantation Source Type: research

The effects of vitamin K supplementation and vitamin K antagonists on progression of vascular calcification: ongoing randomized controlled trials
Conclusion Vitamin K deficiency may be a modifiable cardiovascular risk factor in the haemodialysis population. Conversely, vitamin K antagonists may aggravate VC burden in haemodialysis patients. Several ongoing trials may provide an answer to these questions in the near future.
Source: CKJ: Clinical Kidney Journal - March 15, 2016 Category: Urology & Nephrology Authors: Caluwe, R., Pyfferoen, L., De Boeck, K., De Vriese, A. S. Tags: CKD-MBD Source Type: research

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