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Warfarin Increases Risk of Stroke in Some Patients on Dialysis WASHINGTON, DC -- August 27, 2009 -- Warfarin may increase the risk of stroke in patients with kidney disease who are on dialysis, according to a study published early online and appearing in an upcoming issue of the Journal of the American Society Nephrology. The results suggest that warfarin should be prescribed with caution in patients with renal failure. Kevin Chan, MD, Fresenius Medical Care North America, Waltham, Massachusetts, and colleagues studied 1,671 patients with end stage renal disease (ESRD) and a diagnosis of atrial fibrillation who started dialysis in clinics operated by Fresenius Medical Care North America. Patients' health was monitored for an average of 1.6 years after dialysis was started. The researchers found that patients who took warfarin increased their risk of stroke; however, the increase in risk was related to the degree of blood thinning in response to the drug. Dialysis patients whose blood was not monitored for warfarin levels after they received the drug had the highest risk of stroke (almost 3-fold higher than patients not on warfarin). Notably, clopidogrel and aspirin did not increase dialysis patients' risk of stroke. Additional research is needed to determine why warfarin has the opposite effect on stroke risk in kidney disease patients on dialysis compared with other individuals. One possible explanation maybe because bleeding is a well known complication of kidney failure and the concomitant use of blood thinners may exaggerate the risk of stroke from bleeding in the head. The study's findings should be validated through randomised controlled clinical trials. "Until then, physicians should be cognizant of the possible risks associated with warfarin use for atrial fibrillation in ESRD patients with careful evaluation of the risks and benefits of intervention at the individual patient level," the authors concluded. SOURCE: American Society of Nephrology E-mail this page to a friend or colleague! To print, use this version