Overanticoagulation is associated with renal function decline

Nico Blijderveen, Katia Verhamme, R. Zietse, Loes Visser, Silvana Romio, PN Buhre, MCJM Sturkenboom, Bert Hofman, Sabine Straus, Bruno Stricker

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8 Citations (Scopus)


Background: Recent studies suggest that overanticoagulation impairs renal function in patients on warfarin therapy, due to renal tubular obstruction from glomerular hemorrhage. Methods: Data from the Rotterdam Study (The Netherlands), a prospective population-based cohort study of patients 55 years and older, were used for this study. Information on vitamin K antagonist (VKA) therapy was obtained from the regional anticoagulation clinic, where prothrombin times were monitored every 1-6 weeks depending on target level and stability of the international normalized ratio (INR). Linear regression was performed to study the association between the cumulative number of insta Results: Information was available for analysis on 2,802 study participants in whom overanticoagulation was significantly associated with a decline in renal function, after adjustment for confounding by age, sex, heart failure, baseline glomerular filtration rate and indication for VKA therapy (-0.180 ml/min per 1.73 m(2) per year per event for INR >6.0, p = 0.030). Conclusions: Overanticoagulation (INR >6.0) is associated with a decline in renal function. Further studies are needed to evaluate the causal role of different degrees of overanticoagulation, including transient effects, in high-risk groups, and the association with the new oral anticoagulants.
Original languageUndefined/Unknown
Pages (from-to)691-698
Number of pages8
JournalJournal of Nephrology
Issue number4
Publication statusPublished - 2013

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