Changes to prothrombin international normalized ratio in patients receiving hemodialysis

Background: The clinical utility of factor Xa inhibitors (xabans) has been demonstrated, but these inhibitors are contraindicated in patients undergoing dialysis therapy. Therefore, warfarin remains the mainstay for oral anticoagulation treatment of patients receiving hemodialysis (HD). Objective: This study investigated the changes in international normalized ratio (INR) during HD treatment of patients receiving warfarin. Methods: Changes in INR and serum albumin levels were determined before (pre-) and after (post-) HD in six consecutive HD sessions. 30 patients (23 males, 7 females; mean age, 72 +/- 8 years) were enrolled, and a total of 180 measurements were performed. Results: Post-HD INR levels were significantly decreased compared with pre-HD levels (2.07 +/- 0.52 to 1.99 +/- 0.50, p < 0.0001), while serum albumin levels were significantly increased post-HD compared with pre-HD (p < 0.0001). There was a significant negative correlation between changes in INR and serum albumin during HD (r = -0.383, p = 0.0002). Conclusion: INR is significantly decreased post-HD compared with pre-HD. Although the therapeutic range of INR differs according to the disease, close monitoring of the degree of anticoagulation in patients receiving warfarin is recommended to minimize the risk of thrombosis and hemorrhagic complications.