Consequences of oral antithrombotic use in patients with chronic kidney disease. Issue 6 (24th June 2021)

• Record Type: Journal Article
• Authors: Laville, Solène M.; Lambert, Oriane; Hamroun, Aghiles; Metzger, Marie; Jacquelinet, Christian; Laville, Maurice; Frimat, Luc; Fouque, Denis; Combe, Christian; Ayav, Carole; Pecoits‐Filho, Roberto; Stengel, Bénédicte; Massy, Ziad A.; Liabeuf, Sophie
• Other Names: Hannedouche Thierry investigator.; Moulin Bruno investigator.; Mailliez Sébastien investigator.; Lebrun Gaétan investigator.; Magnant Eric investigator.; Choukroun Gabriel investigator.; Deroure Benjamin investigator.; Lacraz Adeline investigator.; Lambrey Guy investigator.; Philippe Jean investigator.; Essig Marie investigator.; Lobbedez Thierry investigator.; Azar Raymond investigator.; Sekhri Hacène investigator.; Smati Mustafa investigator.; Jamali Mohamed investigator.; Klein Alexandre investigator.; Delahousse Michel investigator.; Martin Séverine investigator.; Landru Isabelle investigator.; Thervet Eric investigator.; Lang Philippe investigator.; Belenfant Xavier investigator.; Urena Pablo investigator.; Vela Carlos investigator.; Chauveau Dominique investigator.; Panescu Viktor investigator.; Noel Christian investigator.; Glowacki François investigator.; Hoffmann Maxime investigator.; Hourmant Maryvonne investigator.; Besnier Dominique investigator.; Testa Angelo investigator.; Kuentz François investigator.; Zaoui Philippe investigator.; Chazot Charles investigator.; Juillard Laurent investigator.; Burtey Stéphane investigator.; Keller Adrien investigator.; Kamar Nassim investigator.;
• Is Part Of: Clinical and translational science. Volume 14:Issue 6(2021)
• Page Start: 2242
• Page End: 2253
• Publication Date: 2021-06-24
• Subjects: Medicine, Experimental -- Periodicals; Medical innovations -- Periodicals; 616.027
• DOI: 10.1111/cts.13084
• Languages: English
• ISSNs: 1752-8054

Abstract

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.