Journal of Thrombosis and Thrombolysis

, Volume 45, Issue 4, pp 557–561 | Cite as

Incidence and risk factors for acute kidney injury in patients with excessive anticoagulation on warfarin: a retrospective study

  • Siavash Piran
  • Hugh Traquair
  • Noel Chan
  • Marlene Robinson
  • Sam Schulman


Anticoagulant-related nephropathy is an acute kidney injury (AKI) associated with excessive anticoagulation. The nature of the association between excessive anticoagulation with warfarin and AKI and its incidence remain unclear. To evaluate the incidence of AKI in excessively anticoagulated patients taking warfarin and examine potential risk factors. A retrospective chart review was performed in patients on chronic warfarin. The primary outcome was AKI, defined as an acute increase in creatinine of > 26.5 µmol/L within 7–14 days of an international normalized ratio (INR) ≥ 4.0. 292 patients with an INR ≥ 4.0 were included. 101 patients had CKD and 191 did not have CKD. Of the 292 patients with an INR ≥ 4.0, 38 (13%) had an AKI. In univariable analyses, CKD [odds ratio (OR) 2.1, 95% confidence interval (CI) 0.99–4.43] and use of renin–angiotensin system (RAS) blockers and/or diuretics (OR 3.85; 95% CI 1.15–20.15) were significantly associated with the risk of AKI. In a binomial logistic regression model, use of RAS blockers and/or diuretics was the only significant predictor of AKI (OR 3.4; 95% CI 1.02–11.76). Use of RAS blockers and/or diuretics significantly increased the risk of AKI in patients with warfarin-related excessive anticoagulation. Further prospective studies examining the association of high INRs and AKI are needed.


Acute kidney injury Anticoagulants Creatinine, international normalized ratio Warfarin 



SP was a recipient of a CanVECTOR thrombosis fellowship.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Siavash Piran
    • 1
    • 2
  • Hugh Traquair
    • 1
  • Noel Chan
    • 1
  • Marlene Robinson
    • 1
  • Sam Schulman
    • 1
  1. 1.Division of Hematology and Thromboembolism, Department of Medicine, and Thrombosis and Atherosclerosis Research InstituteMcMaster UniversityHamiltonCanada
  2. 2.Thrombosis ServiceHHS - General HospitalHamiltonCanada

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