Cohort study on the quality of oral anticoagulation therapy in chronic haemodialysis patients treated with phenprocoumon

Abstract

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.