Abstract
RATIONALE & OBJECTIVE: Patients with kidney failure requiring maintenance dialysis have a high risk of cardiovascular events warranting antithrombotic therapies, including oral anticoagulant (OAC) or antiplatelet therapy (APT). However, chronic use of antithrombotic therapy can increase the bleeding risk in patients receiving dialysis. However, little is known about medication use patterns and risk of bleeding events in real-world clinical practice. STUDY DESIGN: Retrospective analysis of data from 2 prospective cohort studies. SETTING & PARTICIPANTS: We included 27,612 patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS) and 5,289 patients from the Peritoneal DOPPS (PDOPPS), international cohorts of hemodialysis (HD) and peritoneal dialysis (PD) patients. EXPOSURES: Patient demographics and comorbid conditions; OAC and APT use. OUTCOMES: OAC and APT use; a bleeding composite outcome including a hospitalization or death because of a major bleeding event. ANALYTICAL APPROACH: Descriptive analyses to explore OAC and APT utilization and crude rates of the bleeding composite outcome and Kaplan-Meier analyses to estimate medication discontinuation. RESULTS: Baseline OAC and APT use was 9% and 10% in HD patients and 4% and 7% in PD patients, respectively. Patients prescribed antithrombotic drugs were older and more likely to have a history of cardiovascular disease. After 36 months, the Kaplan-Meier estimated proportions of baseline users who remained on therapy were 57% for OAC and 53% for APT. The composite bleeding rates per 100 patient-years among patients with baseline OAC use versus baseline APT use versus neither were 8.6, 5.6, and 4.1 in HD patients and 12.0, 6.1, and 3.9 in PD patients, respectively. LIMITATIONS: Potential for event misclassification; no over-the-counter medication data; rates unadjusted. CONCLUSIONS: Antithrombotic drugs are infrequently prescribed and often discontinued in patients receiving HD or PD. With major bleeding event rates high among antithrombotic users, new strategies are needed to optimize the risks and benefits of antithrombotic agents in the dialysis setting.