Abstract
Few studies have been published on the control of oral anticoagulation treatment in end stage renal disease (ESRD). To analyse the quality of oral anticoagulation treatment control in ESRD patients treated with phenprocoumon we conducted a cohort study including all patients on chronic haemodialysis at a reference date. Data were collected retrospectively for 12 months and prospectively for 12 months preceding following the reference date. Endpoint was the percentage of INR in target range. 30 (27%) of 111 patients received oral anticoagulation treatment. The median frequency of INR measurements was every 6.5 days (range 1-16). In median 54% (range 17-74%) and 49% (range 21-65%) of INR measurements were within, 17% (range 0-45%) and 19% (range 4-56%) were above and 27% (range 8-83%) and 33% (range 9-57%) were below the target range in the retrospective and prospective dataset, respectively. The percentage of INR measurements within target range was significantly higher in patients with a target range width of 1.0 than in patients with a target range width of 0.5 (p = 0.04). There was no difference in the number of bleedings or thromboembolic events in patients with and without oral anticoagulation treatment. In our ESRD cohort, the percentage of INR in target range in patients treated with phenprocoumon seems comparable with published data on warfarin and data in non-ESRD populations. However, this finding has to be confirmed in larger studies powered for analysing the factors influencing INR control and the impact of INR control on bleeding and thromboembolic events in ESRD patients treated with phenprocoumon.
Highlights
The standard intervention for therapy and prevention of thromboembolic events is oral anticoagulation therapy (OAT) with vitamin K antagonists
In our ESRD cohort, the percentage of INR in target range in patients treated with phenprocoumon seems comparable with published data on warfarin and Abbreviations AF atrial fibrillation ASA acetylsalicylic acid CAD coronary artery disease CVA cerebrovascular accident DM diabetes mellitus ESRD end stage renal disease INR international normalised ratio OAT oral anticoagulation treatment Peripheral arterial disease (PAD) peripheral arterial disease platelet aggregation inhibitors (PAI) platelet aggregation inhibitor Permanent catheter (PC) permanent tunnelled central venous catheter data in non-ESRD populations
This finding has to be confirmed in larger studies powered for analysing the factors influencing INR control and the impact of INR control on bleeding and thromboembolic events in ESRD patients treated with phenprocoumon
Summary
The standard intervention for therapy and prevention of thromboembolic events is oral anticoagulation therapy (OAT) with vitamin K antagonists. OAT has a narrow therapeutic range with risk of bleeding in over-anticoagulation and risk of thromboembolism in under-anticoagulation [1]. It is monitored by measurement of prothrombin time, expressed as international normalised ratio (INR) [2, 3]. In recently published randomized controlled trials comparing safety and efficacy of factor Xa and thrombin inhibitors to warfarin in patients with AF or acute venous thromboembolism, 50 to 67% of INRs in the warfarin group were in target range [8,9,10,11,12,13,14,15]
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