Patients with reduced kidney function require lower doses of the anticoagulant drug warfarin, and may need closer monitoring to avoid serious bleeding complications, suggests a study in the April 2009 issue of the Journal of the American Society of Nephrology (JASN).
Among patients who take blood thinner there is a high prevalence of reduced kidney function, ranging from mild to severe. "Although warfarin is very effective in protecting against blood clots it can also cause serious bleeding complications," commented lead author Nita A. Limdi, PharmD, PhD, of the University of Alabama at Birmingham. "The information in our study may help doctors customize warfarin management in patients with kidney failure and lower the risk of complications," commented Michael Allon, MD, also of the University of Alabama at Birmingham.
The researchers evaluated responses to warfarin, the most widely used oral anticoagulant drug, in 578 patients. About 60 percent of the patients had normal or mildly reduced kidney function. Another 30 percent had moderate reductions in kidney function, common in older adults. The remaining patients, nearly ten percent, had kidney failure requiring dialysis.
Warfarin dose was significantly affected by kidney function. The influence of kidney function remained significant even after accounting for medications and the two genes (CYP2C9 and VKORC1) that have been shown to influence warfarin dose. For dialysis patients with kidney failure, a lower dose of warfarin achieved the desired blood-thinning effect. Patients with kidney failure were also more likely to develop serious bleeding complications related to warfarin, regardless of other risk factors. "Patients with renal failure may require closer monitoring to maintain their warfarin in the desired range," said Dr. Limdi.
Even moderately reduced kidney function affected patients' response to blood thinner. These patients also required a lower dose of warfarin, although they were not at increased risk of serious bleeding. The results have important implications for a large proportion of patients who take warfarin. "Warfarin therapy is prescribed and managed similarly in patients with reduced kidney function as in the general medical population," according to Dr. Allon. "However, in our study patients with reduced renal function and renal failure required lower doses. Forty percent of study participants fell into these categories. This highlights that kidney function may be an important factor to consider in patients being prescribed warfarin," said Dr. Limdi.
Patients with kidney failure are at higher risk of serious bleeding. "Further studies are required to understand the harm and benefit associated with warfarin therapy in patients with kidney failure," said Dr. Limdi.
The study had some important limitations, including a lack of data on patients who developed blood clots despite being on warfarin. "Therefore we hesitate to recommend the use of kidney function in making treatment decisions," Dr. Limdi added. "Perhaps ongoing and future research efforts evaluating both clotting and bleeding events will enable more balanced clinical decision making in this unique and medically challenging patient population."
Shari Leventhal | EurekAlert!
Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung
High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.
"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...
COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.
In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...
'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.
Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...
14.10.2016 | Event News
14.10.2016 | Event News
12.10.2016 | Event News
21.10.2016 | Health and Medicine
21.10.2016 | Information Technology
21.10.2016 | Materials Sciences