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NDT Plus Advance Access published online on November 3, 2009
NDT Plus, doi:10.1093/ndtplus/sfp150
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Kidney transplantation without reversal of warfarin

David W. Mudge1, Scott B. Campbell1 and Mark Ray2

1 Department of Nephrology, University of Queensland at Princess Alexandra Hospital
2 Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Correspondence: David W. Mudge; E-mail: david_mudge{at}health.qld.gov.au


  Abstract

Some patients called for kidney transplantation are anticoagulated with warfarin for indications such as antiphospholipid syndrome, where the risk of thrombosis with reversal may be high. Traditionally, the approach has been reversal of warfarin and treatment perioperatively with intravenous unfractionated heparin. However, this may be complicated by either thrombosis or bleeding if the heparin dose is incorrect. We report the case of a peritoneal dialysis patient warfarinized for antiphospholipid syndrome who was successfully transplanted with an international normalized ratio of 2.1 with neither thrombosis nor bleeding. This may be an alternative to heparin for patients in whom anticoagulation must be maintained.

Key Words: anticoagulation • antiphospholipid syndrome • kidney transplantation • warfarin

Received for publication September 22, 2009. Accepted for publication September 25, 2009.


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