Thrice weekly warfarin administration in haemodialysis patients
| Autor: | Joe Bueti, Amy R. Sood, Lisa M. Soederberg Miller, Martina Reslerova, Manish M. Sood, Paul Komenda, Arjuna Ponnampalam, Cory Lang, Claudio Rigatto |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Pilot Projects Drug Administration Schedule law.invention End stage renal disease Randomized controlled trial law Renal Dialysis Internal medicine medicine Humans Dosing International Normalized Ratio Adverse effect Aged Transplantation business.industry Anticoagulant Warfarin Anticoagulants medicine.disease Comorbidity Surgery Nephrology Female Hemodialysis business medicine.drug |
| Zdroj: | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 24(10) |
| ISSN: | 1460-2385 |
| Popis: | Background Medication adherence in haemodialysis patients is often challenging due to a high pill burden, complex and dynamic medication regimens and limited patient self-interest in care. The purpose of this study was to investigate the time within target INR and safety profile of thrice weekly warfarin administration in haemodialysis patients with a clinical indication for anticoagulation and documented nonadherence to medications. Methods Thirty-seven patients from two haemodialysis units in Winnipeg, Manitoba, Canada, were recruited, and 17 patients were treated with thrice weekly warfarin and compared to 20 patients treated with daily warfarin therapy. The patients were followed for 1 year with weekly international normalized ratio (INR), dosage and adverse events recorded. The primary outcome was percentage of time with INR in target and sub ( 4)-therapeutic INR. Adverse events were recorded in the two groups. Results The thrice weekly group had a higher burden of comorbidity (Charlson comorbidity index of 6.35 +/- 1.77 versus 4.55 +/- 1.64, P = 0.003) compared to the daily dosage group. In the thrice weekly dosage group, time within target INR was higher (56.9 versus 49.3%, P = 0.008), and time with supra-therapeutic INR > 4 lower (2.7 versus 4.3%, P = 0.03). Total bleeding events (7 versus 6) and major bleeding events (3 versus 2 events) were similar between the two groups. Conclusion In this pilot study, thrice weekly warfarin appears to be a safe and feasible dosing strategy in a select patient population. A randomized controlled trial of thrice weekly warfarin is warranted. |
| Databáze: | OpenAIRE |
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