I am an endocrinologist in Brooklyn. One of my patient with diabetes is now on dialysis and has developed AF. He has been started in warfarin and there is difficulty in maintaining his INR. I read Coumadin has problems in Dialysis patients and I cannot find much information on use of other antiplatelets in patients on Dialysis.

Your question is a good one in that it has no solid answer.  This continues to be an area of controversy.  We know that warfarin (brand name:Coumadin) may decrease the risk of ischemic stroke in patients with chronic atrial fibrillation but may actually increase the risk of hemorrhagic stroke.  There is known to be an increased risk of complications including gastrointestinal bleeding in dialysis patients.  Measurement of protimes is also very difficult in dialysis patients because of reports of clinically important deficiencies of Vitamin K.  Coumadin has also been reported to cause an increase in vascular calcification and skin necrosis in dialysis patients.  Hence, the decision to use warfarin or Coumadin in dialysis patients must weigh risks and benefits. I, personally, am very conservative about use of warfarin in dialysis patients.

There is a review article that can be accessed at: https://www.ncbi.nlm.nih.gov/pubmed/23322135

Use of the New Oral Anti-coagulant Drugs (NOAD’s) has very limited information and may also carry substantial risks.



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