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NDT Advance Access published online on June 1, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp252
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Thrice weekly warfarin administration in haemodialysis patients

Manish M. Sood1,2,3, Claudio Rigatto1,2,3, Joe Bueti2,3,4, Cory Lang1,5, Lisa Miller2,3,4, Arjuna PonnamPalam6, Martina Reslerova1,2,3, Amy Sood1,3,5 and Paul Komenda1,2,3

1 Boniface General Hospital 2 Section of Nephrology, University of Manitoba 3 Manitoba Renal Program 4 Health Sciences Centre 5 Department of Pharmacy, University of Manitoba 6 University of Manitoba, Winnipeg, Manitoba, Canada

Correspondence and offprint requests to: Manish M. Sood; E-mail: msood{at}sbgh.mb.ca



  Abstract

Background. Medication adherence in haemodialysis patients is often challenging due to a high pill burden, complex and dynamic medication regimens and limited patient self-interest in care. The purpose of this study was to investigate the time within target INR and safety profile of thrice weekly warfarin administration in haemodialysis patients with a clinical indication for anticoagulation and documented nonadherence to medications.

Methods. Thirty-seven patients from two haemodialysis units in Winnipeg, Manitoba, Canada, were recruited, and 17 patients were treated with thrice weekly warfarin and compared to 20 patients treated with daily warfarin therapy. The patients were followed for 1 year with weekly international normalized ratio (INR), dosage and adverse events recorded. The primary outcome was percentage of time with INR in target and sub (<1.5)- and supra (>4)-therapeutic INR. Adverse events were recorded in the two groups.

Results. The thrice weekly group had a higher burden of comorbidity (Charlson comorbidity index of 6.35 ± 1.77 versus 4.55 ± 1.64, P = 0.003) compared to the daily dosage group. In the thrice weekly dosage group, time within target INR was higher (56.9 versus 49.3%, P = 0.008), and time with supra-therapeutic INR > 4 lower (2.7 versus 4.3%, P = 0.03). Total bleeding events (7 versus 6) and major bleeding events (3 versus 2 events) were similar between the two groups.

Conclusion. In this pilot study, thrice weekly warfarin appears to be a safe and feasible dosing strategy in a select patient population. A randomized controlled trial of thrice weekly warfarin is warranted.

Keywords: haemodialysis; warfarin; end-stage renal disease; bleeding events

Received for publication: 5. 3.09
Accepted in revised form: 4. 5.09


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