Vitamin K Antagonists: Beyond Bleeding
Article first published online: 9 JAN 2014
© 2014 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 27, Issue 1, pages 37–41, January–February 2014
How to Cite
Krüger, T. and Floege, J. (2014), Vitamin K Antagonists: Beyond Bleeding. Seminars in Dialysis, 27: 37–41. doi: 10.1111/sdi.12175
- Issue published online: 9 JAN 2014
- Article first published online: 9 JAN 2014
Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinical routine, yet they deserve special consideration in dialysis patients and should influence the decision of whether or not to prescribe vitamin K antagonists in cases lacking clear guidelines. Issues to be taken into consideration in HD patients are the induction or acceleration of cardiovascular calcifications, a 10-fold increased risk of calciphylaxis and problems related to maintaining a target INR range. New anticoagulants like direct thrombin inhibitors are promising but have not yet been approved for ESRD patients. Here, we summarize the nontraditional side effects of coumarins and give recommendations about the use of vitamin K antagonists in ESRD patients.