Consequences of oral antithrombotic use in patients with chronic kidney disease.
Journal
Clinical and translational science
ISSN: 1752-8062
Titre abrégé: Clin Transl Sci
Pays: United States
ID NLM: 101474067
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
revised:
07
04
2021
received:
07
04
2021
accepted:
30
04
2021
pubmed:
4
6
2021
medline:
23
2
2022
entrez:
3
6
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 34080321
doi: 10.1111/cts.13084
pmc: PMC8604253
doi:
Substances chimiques
Anticoagulants
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2242-2253Subventions
Organisme : Amgen
Organisme : Fresenius Medical Care
Organisme : Lilly
Organisme : Baxter
Organisme : Merck Sharp & Dohme-Chibret
Organisme : Sanofi-Genzyme
Organisme : Vifor Fresenius
Organisme : AstraZeneca
Investigateurs
Thierry Hannedouche
(T)
Bruno Moulin
(B)
Sébastien Mailliez
(S)
Gaétan Lebrun
(G)
Eric Magnant
(E)
Gabriel Choukroun
(G)
Benjamin Deroure
(B)
Adeline Lacraz
(A)
Guy Lambrey
(G)
Jean Philippe
(J)
Marie Essig
(M)
Thierry Lobbedez
(T)
Raymond Azar
(R)
Hacène Sekhri
(H)
Mustafa Smati
(M)
Mohamed Jamali
(M)
Alexandre Klein
(A)
Michel Delahousse
(M)
Séverine Martin
(S)
Isabelle Landru
(I)
Eric Thervet
(E)
Philippe Lang
(P)
Xavier Belenfant
(X)
Pablo Urena
(P)
Carlos Vela
(C)
Dominique Chauveau
(D)
Viktor Panescu
(V)
Christian Noel
(C)
François Glowacki
(F)
Maxime Hoffmann
(M)
Maryvonne Hourmant
(M)
Dominique Besnier
(D)
Angelo Testa
(A)
François Kuentz
(F)
Philippe Zaoui
(P)
Charles Chazot
(C)
Laurent Juillard
(L)
Stéphane Burtey
(S)
Adrien Keller
(A)
Nassim Kamar
(N)
Informations de copyright
© 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.
Références
Nat Rev Cardiol. 2011 Feb;8(2):64
pubmed: 21348144
N Engl J Med. 2004 Sep 23;351(13):1296-305
pubmed: 15385656
Int J Nephrol Renovasc Dis. 2009;2:33-7
pubmed: 21694919
Am J Kidney Dis. 2004 Apr;43(4):757-60
pubmed: 15042555
Arch Toxicol. 2019 Jan;93(1):121-136
pubmed: 30324315
J Am Coll Cardiol. 2016 Nov 29;68(21):2272-2283
pubmed: 27884245
Int J Cardiol. 2016 Mar 15;207:335-40
pubmed: 26820363
N Engl J Med. 2012 Aug 16;367(7):625-35
pubmed: 22894575
Arch Mal Coeur Vaiss. 2001 Aug;94(8):839-42
pubmed: 11575214
Clin Kidney J. 2017 Jun;10(3):381-388
pubmed: 28616216
JAMA. 2014 Mar 5;311(9):919-28
pubmed: 24595776
Eur Heart J. 2018 Apr 21;39(16):1330-1393
pubmed: 29562325
Pharmacoepidemiol Drug Saf. 2016 Aug;25(8):935-43
pubmed: 27133538
Am J Kidney Dis. 2009 Dec;54(6):1121-6
pubmed: 19577348
Eur J Clin Pharmacol. 2013 Sep;69(9):1617-33
pubmed: 23619611
TH Open. 2020 Apr 16;4(2):e66-e76
pubmed: 32309772
Circulation. 2013 Jan 15;127(2):224-32
pubmed: 23212720
J Am Coll Cardiol. 2018 Jan 16;71(2):251-252
pubmed: 29325644
Clin Epidemiol. 2018 May 29;10:623-630
pubmed: 29881309
Nephrol Dial Transplant. 2019 Feb 1;34(2):277-286
pubmed: 29635335
Clin Kidney J. 2013 Jun;6(3):266-271
pubmed: 24596657
J Am Soc Nephrol. 2007 Apr;18(4):1307-15
pubmed: 17344421
Eur Heart J. 2017 Mar 21;38(12):869-876
pubmed: 27628431
J Am Coll Cardiol. 2015 Jun 16;65(23):2481-93
pubmed: 26065986
J Clin Med. 2020 Apr 13;9(4):
pubmed: 32294894
Atherosclerosis. 2016 Aug;251:177-182
pubmed: 27341534
Am J Kidney Dis. 2008 Oct;52(4):661-71
pubmed: 18805347
Chest. 2010 Nov;138(5):1093-100
pubmed: 20299623
Int J Clin Pharmacol Ther. 2014 Jun;52(6):504-8
pubmed: 24755133
Nephrol Dial Transplant. 2006 Feb;21(2):411-8
pubmed: 16234286
Kidney Int. 2011 Jul;80(2):181-9
pubmed: 21389969
Stat Methods Med Res. 2007 Jun;16(3):219-42
pubmed: 17621469
Nephrol Dial Transplant. 2020 May 1;35(5):827-836
pubmed: 30169874
Clin Transl Sci. 2021 Nov;14(6):2242-2253
pubmed: 34080321
Therapie. 2016 Sep;71(4):355-63
pubmed: 27203170
Circulation. 2017 Aug 8;136(6):583-596
pubmed: 28784826
PLoS One. 2013;8(4):e57661
pubmed: 23560034
Am J Kidney Dis. 2015 May;65(5):701-9
pubmed: 25468385
Expert Opin Drug Metab Toxicol. 2008 Aug;4(8):1065-74
pubmed: 18680441
Ann Intern Med. 2012 Mar 20;156(6):445-59
pubmed: 22431677
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
Nephrol Dial Transplant. 2019 Jun 1;34(6):923-933
pubmed: 30879070
Kidney Int. 2018 Apr;93(4):986-999
pubmed: 29395338
Circulation. 2013 Jan 22;127(3):365-76
pubmed: 23269489
Am Heart J. 2010 Jun;159(6):1102-7
pubmed: 20569726
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Circulation. 2011 Jun 28;123(25):2946-53
pubmed: 21646496
Clin J Am Soc Nephrol. 2020 Aug 7;15(8):1090-1102
pubmed: 32611662
Chest. 2016 Apr;149(4):951-9
pubmed: 26378611
Res Pract Thromb Haemost. 2019 Mar 05;3(2):207-216
pubmed: 31011705
Clin Kidney J. 2019 Jun 10;13(2):199-207
pubmed: 32296525
Semin Dial. 2015 Mar-Apr;28(2):198-205
pubmed: 24962903
J Thromb Haemost. 2005 Apr;3(4):692-4
pubmed: 15842354
Chest. 2014 Jun;145(6):1370-1382
pubmed: 24356875