The investigators of a study, which was published online Aug. 27 in the Journal of the American Society of Nephrology, have recommended monitoring patients" international normalized ratio (INR) after it was found that hemodialysis patients with atrial fibrillation (AF) receiving warfarin showed a paradoxical increase in stroke rate. The US study of 1,671 dialysis patients with end stage renal disease who also had a diagnosis of atrial fibrillation, or an abnormal heartbeat, showed that the stroke rate was highest amongst warfarin users followed by aspirin, no anticoagulation/antiplatelet drugs and clopidogrel respectively. According to the researchers the findings raise concerns about warfarin therapy in dialysis patients particularly if they do not receive INR monitoring in the first 90 days as they had a nearly three-fold increased risk of stroke as compared with warfarin-nonusers.
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