title: Venous thromboembolism in patients with reduced estimated GFR: a population-based perspective.
abstract: BACKGROUND
  An increased frequency of venous thromboembolism (VTE) has been shown in patients with decreased kidney function measured by decreased estimated glomerular filtration rate (eGFR). However, present practices with respect to VTE prevention and management in patients with decreased eGFR in general population settings are uncertain.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Community investigation of 1,509 metropolitan Worcester, MA, residents with a validated VTE in 1999, 2001, and 2003 with further follow-up for up to 3 years.
  
  
  METHODS
  Patients with VTE classified further according to eGFR on presentation: <30, 30-59, 60-89, or ≥90 mL/min/1.73 m(2) (reference group).
  
  
  RESULTS
  Recurrent VTE, major bleeding episodes, and all-cause mortality.
  
  
  METHODS
  Demographic and clinical characteristics, treatment practices, and study outcomes were extracted from patients' hospital and outpatient medical records; eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
  
  
  RESULTS
  Patients with VTE with eGFR <30 mL/min/1.73 m(2) were at increased risk of recurrent VTE (HR, 1.83; 95% CI, 1.03-3.25), major bleeding episodes (HR, 2.30; 95% CI, 1.28-4.16), and all-cause mortality (HR, 1.70; 95% CI, 1.12-2.57) during a 3-year follow-up. Patients with decreased eGFR also presented with more comorbid conditions and were less likely to be discharged on any form of anticoagulant therapy (72.6%, 81.0%, 82.1%, and 87.3% for eGFR <30, 30-59, 60-89, and ≥90 mL/min/1.73 m(2), respectively; P < 0.001).
  
  
  CONCLUSIONS
  Decreased eGFR status is presumed based on creatinine values on clinical presentation. The impact of drug dosage, timing, type of anticoagulant therapy, and medication adherence on study outcomes could not be evaluated.
  
  
  CONCLUSIONS
  Severe decreases in eGFR are associated with increased risk of long-term recurrent VTE, bleeding, and total mortality in patients with VTE. A greater frequency of serious comorbid conditions, difficulties implementing available management strategies, and suboptimal VTE prophylaxis during hospital admissions likely contributed to our findings.
authors.affiliation: Department of Community Health, Warren Alpert Medical School, Brown University, Providence, RI, USA.
authors.forename: Amisha M
authors.initials: AM
authors.lastname: Parikh
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Catherine
authors.initials: C
authors.lastname: Emery
authors.forename: Ana
authors.initials: A
authors.lastname: Baylin
authors.forename: Crystal
authors.initials: C
authors.lastname: Linkletter
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000503:physiopathology*