Tevlin MT, Portner ME, Kraus MG, Dulaney JT
Clotting frequency of hemodialysis accesses before and after
systemic anticoagulation with coumadin
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1421 1996
This is an interesting although uncontrolled report of 13 patients
treated with warfarin for frequent access thrombosis. Criteria for
treatment seem rather subjective "frequent clotting episodes requiring
radiological or surgical procedures" but in fact the patients appear to
have been pretty serious clotters, with 12.4 +/- 7.6 episodes per year.
Anticoagulation to an INR of 2.5 to 3.0 markedly reduced clotting
episodes (p=0.001), but even during therapy thrombosis incidence
remained 3.7 +/- 3.3 episodes per year.
Comment: These data are suggestive, but 4 episodes of thrombosis per
year hardly
represents impressive success. One wonders whether these patients, with
their horrifyingly high pre-treatment clotting rate, might have included
persons with anti-phospholipid antibodies. Were that the case, an INR
of 2.5 to 3.0 might have been insufficient. Results like this cry out
for better and larger studies of warfarin, both low- and high-dose, for
prevention of access thrombosis, with more complete investigation and
characterization of the treated population.
(Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula