Elsevier

Kidney International

Volume 84, Issue 3, September 2013, Pages 600-608
Kidney International

Clinical Investigation
Major bleeding events and risk stratification of antithrombotic agents in hemodialysis: results from the DOPPS

https://doi.org/10.1038/ki.2013.170Get rights and content
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Benefits and risks of antithrombotic agents remain unclear in the hemodialysis population. To help clarify this we determined variation in antithrombotic agent use, rates of major bleeding events, and factors predictive of stroke and bleeding in 48,144 patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases I–IV. Antithrombotic agents including oral anticoagulants (OACs), aspirin (ASA), and anti-platelet agents (APAs) were recorded along with comorbidities at study entry, and clinical events including hospitalization due to bleeding were then collected every 4 months. There was wide variation in OAC (0.3–18%), APA (3–25%), and ASA use (8–36%), and major bleeding rates (0.05–0.22 events/year) among countries. All-cause mortality, cardiovascular mortality, and bleeding events requiring hospitalization were elevated in patients prescribed OACs across adjusted models. The CHADS2 score predicted the risk of stroke in atrial fibrillation patients. Gastrointestinal bleeding in the past 12 months was highly predictive of major bleeding events; for patients with previous gastrointestinal bleeding, the rate of bleeding exceeded the rate of stroke by at least twofold across all categories of CHADS2 score, including patients at high stroke risk. Appropriate risk stratification and a cautious approach should be considered before OAC use in the dialysis population.

Keywords

anticoagulation
dialysis
end-stage renal disease
mortality risk
survival

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FT is supported in part by NIDDK grant 1K01DK087762-01A1. BMR has received speakers' fees for Kyowa Hakko Kirin. All the other authors declared no competing interests.