Key result
Phenprocoumon achieves target INR levels in chronic hemodialysis patients only ~49% of the time.
Why the study?
Few studies have been published on the control of oral anticoagulation treatment in end stage renal disease patients treated with phenprocoumon.
Does phenprocoumon provide adequate INR control in patients with end stage renal disease on chronic haemodialysis?
Cohort (n=111)
Open-label
No
Does phenprocoumon provide adequate INR control in patients with end stage renal disease on chronic haemodialysis?
Phenprocoumon provides comparable INR control in ESRD patients on hemodialysis to non-ESRD populations, though larger studies are needed to assess clinical outcomes.
May support phenprocoumon use in hemodialysis with INR monitoring; leaves open outcome benefits of wider target ranges.
BACKGROUND: Few studies have been published on the control of oral anticoagulation treatment in end stage renal disease (ESRD). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Praehauser et al. (2012) conducted a cohort in End stage renal disease on chronic haemodialysis (n=111). Phenprocoumon vs. No oral anticoagulation therapy was evaluated on Percentage of INR values within the target range during OAT maintenance. In chronic haemodialysis patients treated with phenprocoumon, the median percentage of INR measurements within the target range during maintenance was 49% prospectively and 54% retrospectively.
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