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2017 ; 10
(3
): 170-7
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Clinical Assessment of Warfarin Therapy in Patients with Maintenance
Dialysis-Clinical Efficacy, Risks and Development of Calciphylaxis
#MMPMID29147170
Hasegawa H
Ann Vasc Dis
2017[Sep]; 10
(3
): 170-7
PMID29147170
show ga
Recent years, multiple studies regarding clinical efficacy and risks of Warfarin
therapy in dialysis patients have been reported, and not a few reports conclude
that clinical advantage of Warfarin is questionable in dialysis patients.
Conversely, its hemorrhagic risk might be a little more serious in dialysis
patients comparing to non-dialysis patients. Basically, it is assumed that
long-term administration of Warfarin accelerates the development of vascular
athelosclerosis because of the abolished anti-calcification effect of Gla-protein
activation by decreased vitamin K activity. This assumption is recently confirmed
by multiple reports, suggesting that the Warfarin administration might be worse
harmful than ever expected in dialysis patients who are essentially considered to
have higher risk of calcification comparing to non-dialysis patients. In
addition, it is recently well considered that the Warfarin administration would
be a risk factor to cause Warfarin skin necrosis or calciphylaxis, therapy
resistant ulcerative skin lesions, which are considered to be highly related to
the Warfarin-induced transient hypercoagulable state or acceleration of
calcification. Therefore, it is considered that the indication of Warfarin
administration to dialysis patients should be carefully assessed. (This is a
translation of Jpn J Vasc Surg 2017; 26: 83-90.).