Internal and Emergency Medicine

, Volume 4, Issue 5, pp 375–380

Oral anticoagulant therapy in hemodialysis patients: do the benefits outweigh the risks?

IM - Review

DOI: 10.1007/s11739-009-0281-0

Cite this article as:
Finazzi, G. & Mingardi, G. Intern Emerg Med (2009) 4: 375. doi:10.1007/s11739-009-0281-0


Managing oral anticoagulation may be difficult in hemodialysis patients because the antithrombotic effect can be counterbalanced by an increased risk of hemorrhagic complications. There is insufficient evidence to recommend the routine use of warfarin for thrombosis prophylaxis of the vascular access in all patients. If a decision for anticoagulation is made, dosing warfarin to a “therapeutic” level is suggested, although the most appropriate target INR range remains unclear. Many hemodialysis patients with atrial fibrillation have multiple risk factors for stroke and generally benefit from warfarin, with careful and frequent laboratory monitoring. Treatment with standard dose warfarin is also recommended in patients with venous thromboembolism provided that patients do not have contraindications to anticoagulation. For those with such contraindications, placement of an inferior vena cava filter is suggested. These recommendations are limited by the almost complete lack of data in dialysis patients. Sound randomized evidence of efficacy and harm for anticoagulation in these patients will likely never be available. Knowledge of the risk of bleeding and thrombosis in anticoagulated and nonanticoagulated dialysis patients could be provided by feasible, well-designed cohort studies.


Oral anticoagulant therapy Hemodialysis Dialysis vascular access Atrial fibrillation Venous thromboembolism 

Copyright information

© SIMI 2009

Authors and Affiliations

  1. 1.Division of HematologyOspedali Riuniti di BergamoBergamoItaly
  2. 2.Nephrology UnitOspedali Riuniti di BergamoBergamoItaly

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