title: Impact of restarting warfarin therapy in renal disease anticoagulated patients with gastrointestinal hemorrhage.
abstract: BACKGROUND
  Atrial fibrillation (AF) is emerging as a major health problem. The prevalence is as high as 32% in patients with renal disease. Gastrointestinal bleeding (GIB) is a frequent complication.
  
  
  OBJECTIVE
  To investigate the hazards of resumption or discontinuation of anticoagulation in renal disease patients after an episode of GIB. DESIGN, SETTINGS, PARTICIPANTS AND MEASUREMENTS: This is a multicenter retrospective cohort of patients with AF on warfarin that developed an episode of GIB. Chronic kidney disease (CKD) was defined by eGFR ≤60 mL/min and end stage renal disease (ESRD) was defined by being on hemodialysis for >3 months. Outcomes were 90-day recurrent gastrointestinal bleeding (GIB), mortality, and stroke/transient ischemic attack (TIA).
  
  
  RESULTS
  Out of 11,513 AF patients, index GIB occurred in 96 ESRD and 159 CKD patients. Outcomes of CKD patients did not differ when compared with patients with normal kidney function. CKD patients who resumed warfarin had decreased stroke/TIA rates (p < 0.0001). There were no significant differences between CKD patients who resumed warfarin versus that did not resume warfarin (p > 0.05). ESRD patients also did not have significant differences in outcomes when compared to patients with normal kidney function restarted on warfarin. However, there was an increase in recurrent GIB and decrease in mortality as well as stroke/TIA when patients with ESRD that restarted warfarin were compared with ESRD patients who did not restart warfarin.
  
  
  CONCLUSIONS
  Study suggests resuming warfarin after an episode of GIB in CKD patients but recommends considering the increased risk of recurrent GIB in ESRD patients.
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University SOM , Detroit, MI 48202 , USA and.
authors.forename: Fatima
authors.initials: F
authors.lastname: Khalid
authors.forename: Waqas
authors.initials: W
authors.lastname: Qureshi
authors.forename: Sophia
authors.initials: S
authors.lastname: Qureshi
authors.forename: Zaid
authors.initials: Z
authors.lastname: Alirhayim
authors.forename: Kiran
authors.initials: K
authors.lastname: Garikapati
authors.forename: Iani
authors.initials: I
authors.lastname: Patsias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin