|
Blood Thinner May Cause Stroke in Dialysis Patients
Reported September 01, 2009
(Ivanhoe Newswire) -- The blood thinner warfarin can prevent strokes
in most people with abnormal heart rhythms such as atrial fibrillation, but
the drug may have the opposite effect in kidney disease patients on
dialysis, according to a new study. The results suggest warfarin should be
prescribed with caution in patients with kidney failure.
Kevin Chan, MD, Michael Lazarus, MD, Raymond Hakim, MD, PhD of Fresenius
Medical Care North America, and Ravi Thadhani, MD of Massachusetts General
Hospital, studied 1,671 end stage renal disease (ESRD) patients with a
diagnosis of atrial fibrillation who started dialysis in clinics operated by
Fresenius Medical Care North America. Their health was monitored for an
average of 1.6 years after dialysis began.
The researchers found patients who took warfarin had an increased risk of
stroke that was directly related to the degree of blood thinning in response
to the drug. Dialysis patients whose blood warfarin levels were not
monitored had the highest risk of stroke, almost three-fold higher than
patients not on warfarin. Notably, two other types of blood thinner --
clopidogrel and aspirin -- did not increase dialysis patients' risk of
stroke.
Additional research is needed to determine why warfain has a negative effect
on stroke risk in kidney disease patients on dialysis. One possible
explanation may be that bleeding is a well known complication of kidney
failure and the concomitant use of blood thinners may exaggerate the risk of
stroke. The researchers concluded, "Physicians should be cognizant of the
possible risks associated with warfarin use for atrial fibrillation in ESRD
patients, with careful evaluation of the risks and benefits of intervention
at the individual patient level."
SOURCE: Journal of the American Society Nephrology (JASN), August 27, 2009 |
