title: Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry.
abstract: BACKGROUND
  Current guidelines make no specific recommendations for venous thromboembolism (VTE) treatment in patients with renal insufficiency, but some experts recommend some reduction in heparin dose.
  
  
  METHODS
  Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. In this analysis we retrospectively analyzed the effect of renal insufficiency on the incidence of fatal pulmonary embolism (PE) and fatal bleeding within 15 days of diagnosis.
  
  
  RESULTS
  Up to March 2005, 10,526 patients with acute VTE were enrolled in RIETE, of whom 9234 (88%) had a creatinine clearance (CrCl) greater than 60 mL/min, 704 (6.7%) had a CrCl 30 to 60 mL/min, and 588 (5.6%) had a CrCl less than 30 mL/min. The incidence of fatal PE during the study period was 1.0%, 2.6%, and 6.6%, respectively. Fatal bleeding occurred in 0.2%, 0.3%, and 1.2% of the patients, respectively. On multivariate analysis, patients with a CrCl less than 30 mL/min were independently associated with an increased risk for fatal PE and fatal bleeding. In addition, initial diagnosis of PE, immobility for 4 days or more, cancer, and initial therapy with unfractionated heparin were independent predictors of fatal PE; whereas immobility for 4 days or more and cancer were independent predictors of fatal bleeding.
  
  
  CONCLUSIONS
  Patients with VTE who have renal insufficiency had an increased incidence of both fatal PE and fatal bleeding, but the risk of fatal PE far exceeded that of fatal bleeding. Our data support the use of full-dose anticoagulant therapy, even in patients with a CrCl less than 30 mL/min.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Germans Trias i Pujol, Badalona, Facultat de Medicinad, Universitat Autónoma de Barcelona, Spain. mmonreal.germanstrias@gencat.net
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
authors.forename: Conxita
authors.initials: C
authors.lastname: Falgá
authors.forename: Reina
authors.initials: R
authors.lastname: Valle
authors.forename: Raquel
authors.initials: R
authors.lastname: Barba
authors.forename: Juan
authors.initials: J
authors.lastname: Bosco
authors.forename: José Luís
authors.initials: JL
authors.lastname: Beato
authors.forename: Ana
authors.initials: A
authors.lastname: Maestre
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology*