Warfarin treatment in ESRD: Survey Results

by Peter Barany

756 answers were received from the readers of NDT-educational. Two thirds of the responders were from Europe and one third from other parts of the world.

The age of the responders was normally distributed peaking at 45-54 years.

Most participants are active in clinical nephrology and/or dialysis

and are hospital-based.

Two thirds of the participants have recently changed opinion regarding warfarin treatment; 54% because of higher risks and 9 % because of more benefits of treatment.

Only 9% think the same guidelines for anticoagulation in patients with atrial fibrillation could be applied in dialysis patients as in patients from  the general population. Nineteen percent think minor modifications of the guidelines are required and 71% think that new guidelines are necessary for this specific group of patients.

The two major risks identified were bleeding and calciphylaxis. Twelve percent did not see any reason to withhold treatment in dialysis patients.

Two thirds think it is more difficult to obtain stable INR in hemodialysis patients than in other patient groups.

21% think there is no alternative to warfarin, 28% believe that low-molecular weight heparin is the best alternative, 25% suggest aspirin and 14% clopidrogel.

It seems that the majority of nephrologists have changed opinion and are concerned regarding the safety of warfarin treatment in ESRD patients. Bleeding and calciphylaxis are the two major recognized complications. Nephrologists also think that it is more difficult to obtain stable INR in dialysis patients and that specific guidelines for this patient group should be developed.

Peter Barany, NDT-Educational Consultant