title: Major bleeding events and risk stratification of antithrombotic agents in hemodialysis: results from the DOPPS.
abstract: 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.
authors.affiliation: Department of Medicine, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. msood99@gmail.com
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Maria
authors.initials: M
authors.lastname: Larkina
authors.forename: Jyothi R
authors.initials: JR
authors.lastname: Thumma
authors.forename: Francesca
authors.initials: F
authors.lastname: Tentori
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: David C
authors.initials: DC
authors.lastname: Mendelssohn
authors.forename: Kevin
authors.initials: K
authors.lastname: Chan
authors.forename: Patricia
authors.initials: P
authors.lastname: de Sequera
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D001241:Aspirin