Why the study?
Does systemic anticoagulation increase the risk of major bleeding and adverse outcomes in hospitalized patients with moderate to severe chronic kidney disease?
Does systemic anticoagulation increase the risk of major bleeding and adverse outcomes in hospitalized patients with moderate to severe chronic kidney disease?
In hospitalized patients with moderate to severe CKD, systemic anticoagulation is associated with increased major bleeding and in-hospital mortality, with unfractionated heparin posing a higher bleeding risk than dose-adjusted enoxaparin.
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Anticoagulation was associated with higher major bleeding in moderate-severe CKD inpatients; leaves open net benefit and requires randomized confirmation.
BACKGROUND: Anticoagulation therapy is usually required in patients with chronic kidney disease (CKD) for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of bleeding. OBJECTIVES: To determine the incidence of adverse outcomes of anticoagulants in hospitalized patients with CKD, and to compare the rates of major bleeding events between the unfractionated heparin (UFH) and enoxaparin users. METHODS: One year prospective observational study was conducted in patients with CKD stages 3 to 5 (estimated GFR, 10-59 ml/min/1.73 m(2)) who were admitted to the renal unit of Dubai Hospital. Propensity scores for the use of anticoagulants, estimated for each of the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox regression method was used to estimate association between anticoagulant use and adverse outcomes. RESULTS: Major bleeding occurred in 1 in 3 patients who received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% confidence interval [CI], 2.05-10.35]). Compared with enoxaparin users, patients who received anticoagulation with unfractionated heparin had a lower mean [SD] serum level of platelet counts (139.95 [113] × 10(3)/µL vs 205.56 [123] × 10(3)/µL; P<0.001), and had a higher risk of major bleeding (HR, 4.79 [95% CI, 1.85-12.36]). Furthermore, compared with those who did not receive anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 [95% CI, 1.03-6.25]); longer length of hospitalization (HR, 1.04 [95% CI, 1.01-1.06]); and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 1.10-2.91]). CONCLUSIONS: Anticoagulation among hospitalized patients with CKD was significantly associated with an increased risk of bleeding and in-hospital mortality. Hence, intensive monitoring and preventive measures such as laboratory monitoring and/or dose adjustment are warranted.
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Sharif‐Askari et al. (2014) studied this question.
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