Consequences of oral antithrombotic use in patients with chronic kidney disease
Abstract We assessed the risks of bleeding, acute kidney injury (AKI), and kidney failure associated with the prescription of antithrombotic agents (oral anticoagulants and/or antiplatelet agents) in patients with moderate‐to‐advanced chronic kidney disease (CKD). CKD‐REIN is a prospective cohort of...
Guardado en:
| Autores principales: | , , , , , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Wiley
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/496f063a74864d888537bfc7d12c9f05 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:496f063a74864d888537bfc7d12c9f05 |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:496f063a74864d888537bfc7d12c9f052021-11-19T17:51:34ZConsequences of oral antithrombotic use in patients with chronic kidney disease1752-80621752-805410.1111/cts.13084https://doaj.org/article/496f063a74864d888537bfc7d12c9f052021-11-01T00:00:00Zhttps://doi.org/10.1111/cts.13084https://doaj.org/toc/1752-8054https://doaj.org/toc/1752-8062Abstract We assessed the risks of bleeding, acute kidney injury (AKI), and kidney failure associated with the prescription of antithrombotic agents (oral anticoagulants and/or antiplatelet agents) in patients with moderate‐to‐advanced chronic kidney disease (CKD). CKD‐REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2–5 at baseline. We used cause‐specific Cox proportional hazard models to estimate hazard ratios (HRs) for bleeding (identified through hospitalizations), AKI, and kidney failure. Prescriptions of oral antithrombotics were treated as time‐dependent variables. At baseline, 339 (11%) patients (65% men; 69 [60–76] years) were prescribed oral anticoagulants only, 1095 (36%) antiplatelets only, and 101 (3%) both type of oral antithrombotics. Over a median (interquartile range [IQR]) follow‐up period of 3.0 (IQR, 2.8–3.1) years, 152 patients experienced a bleeding event, 414 patients experienced an episode of AKI, and 270 experienced kidney failure. The adjusted HRs (95% confidence interval [95% CI]) for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants only, and antiplatelet + oral anticoagulant were, respectively, 0.74 (95% CI, 0.46–1.19), 2.38 (95% CI, 1.45–3.89), and 3.96 (95% CI, 2.20–7.12). An increased risk of AKI risk was associated with the prescription of oral anticoagulants (adjusted HR, 1.90, 95% CI, 1.47–2.45) but not the prescription of antiplatelets (HR, 1.24, 95% CI, 0.98–1.56). Kidney failure was not associated with the prescription of oral antithrombotics of any type. This study confirms the high risk of AKI associated with oral anticoagulants prescription in patients with CKD and also highlights the potential aggravating effect of combining vitamin K antagonist (VKA) and antiplatelets on the risk of bleeding.Solène M. LavilleOriane LambertAghiles HamrounMarie MetzgerChristian JacquelinetMaurice LavilleLuc FrimatDenis FouqueChristian CombeCarole AyavRoberto Pecoits‐FilhoBénédicte StengelZiad A. MassySophie Liabeufthe CKD‐REIN Study CollaboratorsWileyarticleTherapeutics. PharmacologyRM1-950Public aspects of medicineRA1-1270ENClinical and Translational Science, Vol 14, Iss 6, Pp 2242-2253 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Therapeutics. Pharmacology RM1-950 Public aspects of medicine RA1-1270 |
| spellingShingle |
Therapeutics. Pharmacology RM1-950 Public aspects of medicine RA1-1270 Solène M. Laville Oriane Lambert Aghiles Hamroun Marie Metzger Christian Jacquelinet Maurice Laville Luc Frimat Denis Fouque Christian Combe Carole Ayav Roberto Pecoits‐Filho Bénédicte Stengel Ziad A. Massy Sophie Liabeuf the CKD‐REIN Study Collaborators Consequences of oral antithrombotic use in patients with chronic kidney disease |
| description |
Abstract We assessed the risks of bleeding, acute kidney injury (AKI), and kidney failure associated with the prescription of antithrombotic agents (oral anticoagulants and/or antiplatelet agents) in patients with moderate‐to‐advanced chronic kidney disease (CKD). CKD‐REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2–5 at baseline. We used cause‐specific Cox proportional hazard models to estimate hazard ratios (HRs) for bleeding (identified through hospitalizations), AKI, and kidney failure. Prescriptions of oral antithrombotics were treated as time‐dependent variables. At baseline, 339 (11%) patients (65% men; 69 [60–76] years) were prescribed oral anticoagulants only, 1095 (36%) antiplatelets only, and 101 (3%) both type of oral antithrombotics. Over a median (interquartile range [IQR]) follow‐up period of 3.0 (IQR, 2.8–3.1) years, 152 patients experienced a bleeding event, 414 patients experienced an episode of AKI, and 270 experienced kidney failure. The adjusted HRs (95% confidence interval [95% CI]) for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants only, and antiplatelet + oral anticoagulant were, respectively, 0.74 (95% CI, 0.46–1.19), 2.38 (95% CI, 1.45–3.89), and 3.96 (95% CI, 2.20–7.12). An increased risk of AKI risk was associated with the prescription of oral anticoagulants (adjusted HR, 1.90, 95% CI, 1.47–2.45) but not the prescription of antiplatelets (HR, 1.24, 95% CI, 0.98–1.56). Kidney failure was not associated with the prescription of oral antithrombotics of any type. This study confirms the high risk of AKI associated with oral anticoagulants prescription in patients with CKD and also highlights the potential aggravating effect of combining vitamin K antagonist (VKA) and antiplatelets on the risk of bleeding. |
| format |
article |
| author |
Solène M. Laville Oriane Lambert Aghiles Hamroun Marie Metzger Christian Jacquelinet Maurice Laville Luc Frimat Denis Fouque Christian Combe Carole Ayav Roberto Pecoits‐Filho Bénédicte Stengel Ziad A. Massy Sophie Liabeuf the CKD‐REIN Study Collaborators |
| author_facet |
Solène M. Laville Oriane Lambert Aghiles Hamroun Marie Metzger Christian Jacquelinet Maurice Laville Luc Frimat Denis Fouque Christian Combe Carole Ayav Roberto Pecoits‐Filho Bénédicte Stengel Ziad A. Massy Sophie Liabeuf the CKD‐REIN Study Collaborators |
| author_sort |
Solène M. Laville |
| title |
Consequences of oral antithrombotic use in patients with chronic kidney disease |
| title_short |
Consequences of oral antithrombotic use in patients with chronic kidney disease |
| title_full |
Consequences of oral antithrombotic use in patients with chronic kidney disease |
| title_fullStr |
Consequences of oral antithrombotic use in patients with chronic kidney disease |
| title_full_unstemmed |
Consequences of oral antithrombotic use in patients with chronic kidney disease |
| title_sort |
consequences of oral antithrombotic use in patients with chronic kidney disease |
| publisher |
Wiley |
| publishDate |
2021 |
| url |
https://doaj.org/article/496f063a74864d888537bfc7d12c9f05 |
| work_keys_str_mv |
AT solenemlaville consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT orianelambert consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT aghileshamroun consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT mariemetzger consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT christianjacquelinet consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT mauricelaville consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT lucfrimat consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT denisfouque consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT christiancombe consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT caroleayav consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT robertopecoitsfilho consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT benedictestengel consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT ziadamassy consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT sophieliabeuf consequencesoforalantithromboticuseinpatientswithchronickidneydisease AT theckdreinstudycollaborators consequencesoforalantithromboticuseinpatientswithchronickidneydisease |
| _version_ |
1718420009396469760 |