PMID- 27133538
OWN - NLM
STAT- MEDLINE
DCOM- 20170928
LR  - 20180601
IS  - 1099-1557 (Electronic)
IS  - 1053-8569 (Linking)
VI  - 25
IP  - 8
DP  - 2016 Aug
TI  - Antiplatelet and oral anticoagulant therapies in chronic hemodialysis patients: 
      prescribing practices and bleeding risk.
PG  - 935-43
LID - 10.1002/pds.4002 [doi]
AB  - PURPOSE: Results of previous studies assessing the risk of bleeding associated 
      with prescription of antiplatelet (AP) and/or oral anticoagulant (AC) therapy to 
      hemodialysis patients are conflicting. Our purpose was to describe practices for 
      prescription of AP and AC in hemodialysis patients in the Lorraine region, and to 
      assess their effect on the risk of major bleeding events. METHODS: All adults 
      with chronic kidney disease who began a first renal replacement therapy by 
      hemodialysis in 2009 or 2010 in one of the 12 dialysis centers in Lorraine were 
      included in the Thrombosis and Hemorrhage in HemoDialysis patients (T2HD) study 
      and followed up until 30 June 2013. The association of each treatment (AP, AC, 
      AP + AC) with the risk of major bleeding was estimated by three Cox proportional 
      hazard models with an inverse probability of treatment weighting on a propensity 
      score, considering the untreated patients as the reference. RESULTS: Among 502 
      patients included, 227 (45.2%) received an AP, 68 (13.5%) an AC, 81 (16.1%) a 
      combination AP + AC, and 126 (25.1%) were untreated. As compared with untreated 
      patients, those given AP (HR 5.52, 95% CI [3.11-9.80]), AC (HR: 4.15, 95% CI: 
      [3.46-4.99]), and AP + AC (HR: 5.59, 95% CI [2.62-11.91]) were at greater risk of 
      major bleeding events. CONCLUSIONS: The risk of major bleeding is higher in 
      patients receiving an oral AC compared with untreated patients and those 
      receiving an AP agent. A combination of the two drugs does not seem to increase 
      the risk. Copyright (c) 2016 John Wiley & Sons, Ltd.
CI  - Copyright (c) 2016 John Wiley & Sons, Ltd.
FAU - Collette, Camille
AU  - Collette C
AD  - Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, 
      France.
FAU - Clerc-Urmes, Isabelle
AU  - Clerc-Urmes I
AD  - Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, 
      University Hospital of Nancy, Nancy, France.
FAU - Laborde-Casterot, Herve
AU  - Laborde-Casterot H
AD  - Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, 
      France.
AD  - Department of Occupational Medicine and Occupational Pathology, University 
      Hospital of Bordeaux, Bordeaux, France.
FAU - Frimat, Luc
AU  - Frimat L
AD  - Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, 
      France.
AD  - Department of Nephrology, University Hospital of Nancy, Nancy, France.
FAU - Ayav, Carole
AU  - Ayav C
AD  - Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, 
      University Hospital of Nancy, Nancy, France.
FAU - Peters, Nicolas
AU  - Peters N
AD  - Department of Nephrology, University Hospital of Nancy, Nancy, France.
FAU - Martin, Alexandre
AU  - Martin A
AD  - Department of Nephrology, University Hospital of Nancy, Nancy, France.
FAU - Agrinier, Nelly
AU  - Agrinier N
AD  - Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, 
      France.
AD  - Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, 
      University Hospital of Nancy, Nancy, France.
FAU - Thilly, Nathalie
AU  - Thilly N
AD  - Lorraine University, Paris-Descartes University, Apemac, EA 4360 Apemac, Nancy, 
      France.
AD  - Clinical Epidemiology and Evaluation, INSERM CIC 1433-Clinical Epidemiology, 
      University Hospital of Nancy, Nancy, France.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160501
PL  - England
TA  - Pharmacoepidemiol Drug Saf
JT  - Pharmacoepidemiology and drug safety
JID - 9208369
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cohort Studies
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Probability
MH  - Proportional Hazards Models
MH  - Renal Dialysis/*methods
MH  - Renal Insufficiency, Chronic/*therapy
MH  - Retrospective Studies
MH  - Risk
OTO - NOTNLM
OT  - antiplatelet agent
OT  - bleeding events
OT  - hemodialysis
OT  - oral anticoagulant
OT  - pharmacoepidemiology
OT  - prescribing practices
EDAT- 2016/05/03 06:00
MHDA- 2017/09/29 06:00
CRDT- 2016/05/03 06:00
PHST- 2015/08/20 00:00 [received]
PHST- 2016/01/19 00:00 [revised]
PHST- 2016/03/07 00:00 [accepted]
PHST- 2016/05/03 06:00 [entrez]
PHST- 2016/05/03 06:00 [pubmed]
PHST- 2017/09/29 06:00 [medline]
AID - 10.1002/pds.4002 [doi]
PST - ppublish
SO  - Pharmacoepidemiol Drug Saf. 2016 Aug;25(8):935-43. doi: 10.1002/pds.4002. Epub 
      2016 May 1.