title: Antiplatelet and oral anticoagulant therapies in chronic hemodialysis patients: prescribing practices and bleeding risk.
abstract: Results of previous studies assessing the risk of bleeding associated with prescription of antiplatelet (AP) and/or oral anticoagulant (AC) therapy to hemodialysis patients are conflicting. Our purpose was to describe practices for prescription of AP and AC in hemodialysis patients in the Lorraine region, and to assess their effect on the risk of major bleeding events.
  
  
  
  All adults with chronic kidney disease who began a first renal replacement therapy by hemodialysis in 2009 or 2010 in one of the 12 dialysis centers in Lorraine were included in the Thrombosis and Hemorrhage in HemoDialysis patients (T2HD) study and followed up until 30 June 2013. The association of each treatment (AP, AC, AP + AC) with the risk of major bleeding was estimated by three Cox proportional hazard models with an inverse probability of treatment weighting on a propensity score, considering the untreated patients as the reference.
  
  
  
  Among 502 patients included, 227 (45.2%) received an AP, 68 (13.5%) an AC, 81 (16.1%) a combination AP + AC, and 126 (25.1%) were untreated. As compared with untreated patients, those given AP (HR 5.52, 95% CI [3.11-9.80]), AC (HR: 4.15, 95% CI: [3.46-4.99]), and AP + AC (HR: 5.59, 95% CI [2.62-11.91]) were at greater risk of major bleeding events.
  
  
  
  The risk of major bleeding is higher in patients receiving an oral AC compared with untreated patients and those receiving an AP agent. A combination of the two drugs does not seem to increase the risk. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Collette
authors.affiliation: Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, University Hospital of Nancy, Nancy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Clerc-Urmès
authors.affiliation: Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, France.|Department of Occupational Medicine and Occupational Pathology, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Laborde-Castérot
authors.affiliation: Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, France.|Department of Nephrology, University Hospital of Nancy, Nancy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
authors.affiliation: Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, University Hospital of Nancy, Nancy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ayav
authors.affiliation: Department of Nephrology, University Hospital of Nancy, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Peters
authors.affiliation: Department of Nephrology, University Hospital of Nancy, Nancy, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Martin
authors.affiliation: Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, France.|Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, University Hospital of Nancy, Nancy, France.
authors.forename: Nelly
authors.initials: N
authors.lastname: Agrinier
authors.affiliation: Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, France.|Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, University Hospital of Nancy, Nancy, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011336:Probability; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet agent; bleeding events; hemodialysis; oral anticoagulant; pharmacoepidemiology; prescribing practices