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The Impact of Warfarin on Patients with End Stage Renal Disease

DOI: 10.1155/2014/542034

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Abstract:

Introduction. A deficiency in vitamin K through the utilization of warfarin may result in increased vascular calcification and complications. This study aimed to determine the impact of warfarin administration on patients with end stage renal disease (ESRD) in a large, national sample. Methods. A retrospective analysis using the 2005–2010 National Inpatient Sample (NIS), a part of the Health Care Utilization Project (HCUP), was completed using ICD-9 diagnosis codes to capture patients with ESRD prescribed and not prescribed warfarin. Statistical analysis was through ANOVA and chi-squared testing. Results. From 2005–2010, 927,814 patients with ESRD were identified nationally. 3.5% (32,737) were prescribed warfarin. Patients prescribed warfarin had an average age of 64 years and 51% were male. For every comorbid condition (amputation, congestive heart failure, chronic obstructive pulmonary disorder, cerebrovascular accident, diabetes, hypertension, myocardial infarction, peripheral vascular diasese, and valvular disease) patients prescribed Warfarin had significantly higher rates of disease as compared to their nonwarfarin ESRD counterparts. ESRD patients prescribed warfarin had significantly shorter length of stay but increased hospital charges. They were more likely to be discharged to home and had significantly decreased in-hospital mortality. Conclusion. Patients with ESRD taking warfarin are more likely to have comorbidities and/or complications but have a decreased LOS and in-hospital mortality compared to their ESRD counterparts not administered warfarin. 1. Introduction Vascular calcification is associated with increasing age and advancing atherosclerotic plaque [1]. While the arterial system is impacted systemically by this pathology, calcification of the coronary vasculature specifically has been correlated with an increased risk of cardiac events rooted in plaque instability and subsequent rupture [2]. Patients with end stage renal disease (ESRD) have a 2- to 5-fold increase in coronary artery calcification compared to healthy, age-matched individuals, which results in a 10–30 times greater risk of mortality from cardiovascular events [1, 2]. While vascular calcification in ESRD patients was originally considered to be a passive process resulting from progressive inflammation and subsequent atherosclerotic development, newer data suggests that active upregulation of various bone matrix proteins and calcium-regulatory hormones is instrumental in the development of vascular calcification [2]. Vitamin K is an essential factor to a hepatic

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