warfarin with CKD

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person011

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I have heard mixed things on this. I read things saying it is ok and can improve mortality and then other places say don't use it????

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Do you mean just giving coumadin for somebody with CKD, because of their CKD? Because that sounds like a horror show. And also seems like a post for the "Other Supspecialties" forum, not Cards.
 
Do you mean just giving coumadin for somebody with CKD, because of their CKD? Because that sounds like a horror show. And also seems like a post for the "Other Supspecialties" forum, not Cards.

No if someone with CKD has new onset A Fib. Was told coumadin can increase time to HD
 
haven't heard or read anything about warfarin and rate of decline in GFR for CKD patients. there's no indication to anticoagulate people with CKD and no other reason.

however, for AF patients with CKD, they are categorically undertreated as a group because of a fear of increased risk of bleeding. while that risk is real, the increase in thromboembolic risk is even greater - the next iteration of the risk score for AF Chads/Chads-vasc will almost certainly have an "r" in it for renal failure. thus these patients need anticoagulation. Depending on GFR this should be a NOAC where possible - their greatest benefit over warfarin is actually a reduction in bleeding, not a huge gain in efficacy (NNT for apixaban over warfarin to prevent a stroke is around 200). The reduction in bleeding is most pronounced in people with reduced GFR (NNH compared to warfarin falls to around 30 if i recall correctly).

so these folks need anticoagulation, and NOACs trump warfarin (but CAREFUL attention must be paid to dosing and once GFR goes below 15 NOACs are out).
 
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