title: Bleeding Risk of Antithrombotic Treatment in Patients on Hemodialysis.
abstract: BACKGROUND
  The risk-benefit of antithrombotic treatment (ATT) has not been established in patients on dialysis. Our objective was to determine the influence of ATT on the risk of hemorrhage in patients on hemodialysis.
  
  
  METHODS
  We included patients who began dialysis between 2003 and 2007. We determined the rates of fatal bleeding or bleeding leading to hospitalization or transfusion.
  
  
  RESULTS
  Two hundred twenty-one patients were included. Over the follow-up period (45.5 ± 34 months), there were 76 hemorrhages in 52 patients. There were 10 fatal bleedings. The annual incidence of patients presenting with hemorrhagia was 6.2%. Bleeding occurred in 5.2% of those being treated with aspirin, 7% with acenocumarol, 12.3% with clopidogrel, 15.2% with aspirin + clopidogrel, 45.9% with anticoagulants + antiplatelets, 49.6% with low-molecular-weight heparin, and 3.9% without ATT. On multivariate analysis, masculine gender [hazard ratio (HR): 2.421; 95% confidence interval (CI), 1.261-4.650; P = 0.003], treatment with dicumarins (HR: 2.406; 95% CI, 1.013-5.718; P = 0.047), treatment with clopidogrel (HR: 2.697; 95% CI, 1.440-5.051; P = 0.002), and treatment with low-molecular-weight heparin (HR: 21.463; 95% CI, 9.067-50.806; P = 0.001) were independent predictors of bleeding.
  
  
  CONCLUSIONS
  ATT increases the risk of bleeding in patients on hemodialysis. The incidence of hemorrhage varies with the type of antithrombotics used.
authors.affiliation: *Unidad de Gestión Clínica de Cardiología, Complejo Hospitalario de Jaén, Jaén, Spain; †Unidad de Gestión Clínica de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain; and ‡Servicio de Nefrología, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vázquez
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez-Perales
authors.forename: Sonia
authors.initials: S
authors.lastname: Ortega
authors.forename: Teresa
authors.initials: T
authors.lastname: Vázquez-Sánchez
authors.forename: Enrique
authors.initials: E
authors.lastname: Quesada
authors.forename: Daniel
authors.initials: D
authors.lastname: Salas
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Fernández-Guerrero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents