Key result
Pentoxifylline in CKD shows no significant link to increased major bleeding risk versus non-users.
Why the study?
Patients with CKD are frequently treated with antiplatelets because of aberrant haemostasis, but the bleeding risk in CKD patients undergoing pentoxifylline treatment with or without aspirin required evaluation.
Does pentoxifylline increase the risk of major bleeding events in patients with chronic kidney disease?
Cohort
Does pentoxifylline increase the risk of major bleeding events in patients with chronic kidney disease?
Effect estimate: HR 1.19 (95% CI 0.94-1.50)
In patients with chronic kidney disease, pentoxifylline treatment may increase the risk of major bleeding events, particularly at doses exceeding 800 mg/day or in patients with hyperlipidemia, irregular aspirin use, or prior ischemic stroke.
Suggests possible bleeding risk with pentoxifylline in CKD; hypothesis-generating and requires randomized confirmation before practice implications.
Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis. This study aimed to evaluate the bleeding risk with CKD patients undergoing pentoxifylline (PTX) treatment with/without aspirin. In this retrospective study, we used Taiwan's National Health Insurance Research Database to identify PTX treated CKD patients. Patients undergoing PTX treatment after CKD diagnosis were PTX group. A 1:4 age, sex and aspirin used condition matched CKD patients non-using PTX were identified as controls. The outcome was major bleeding event (MBE: intracranial haemorrhage (ICH) and gastrointestinal tract bleeding) during 2-year follow-up period. Risk factors were estimated using Cox regression for overall and stratified analysis. The PTX group had higher MBE risk than controls (hazard ratio (HR) 1.19; 95% confidence interval (CI) 0.94-1.50). In stratified analysis, hyperlipidaemia was a significant risk factor (HR: 1.42; 95% CI 1.01-2.01) of MBE. A daily PTX dose larger than 800 mg, females, non-regular aspirin usage, and ischaemic stroke were risk factors for MBE in PTX group. When prescribing PTX in CKD patients, bleeding should be closely monitored, especially in those with daily dose more than 800 mg, aspirin users, and with a history of ischaemic stroke.
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Fang et al. (2021) conducted a cohort in Chronic kidney disease. Pentoxifylline vs. No pentoxifylline was evaluated on Major bleeding event (intracranial haemorrhage and gastrointestinal tract bleeding) (HR 1.19, 95% CI 0.94-1.50). Pentoxifylline treatment in patients with chronic kidney disease was associated with a higher risk of major bleeding events compared to non-users (HR 1.19; 95% CI 0.94-1.50).
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