T2HD Study. Oral anticoagulants and antiplatelet agents: Practices, benefits, and risks in the chronic hemodialysis population. Observational data

Introduction. - Chronic hemodialysis patients have disorders of hemostasis associated with End Stage Renal Disease, cardiovascular disease, and treatments they receive. They have more thrombotic and bleeding events than the general population. The balance of risks and benefits of drugs is not precisely defined. The aim of this study is to describe the practices patterns concerning oral anticoagulants (AVK) and antiplatelet agents (APA), and to investigate their impact on the survival and the occurrence of thrombotic and bleeding events. Methods. - Based on REIN registry, we performed a multicenter study of 502 incident patients on hemodialysis in Lorraine from 2009 to 2010. Until June 2013, we collected retrospectively the prescription of oral anticoagulants and APA, the occurrence of thrombotic or hemorrhagic events. Results. - During follow-up, there were 550 events, including 454 thrombotic events and 96 bleeding events. The most common event was the dialysis vascular access thrombosis; 60.8% of patients were treated with APA, and 29.5% with AVK. Bleeding and thrombosis occurred the most in the APA plus AVK patient group. Events had often recurrences. Patients survived longer in no anticoagulant or antiplatelet group, but with no statistic difference. Discussion. - Although literature is centered on bleeding events, we found a more significant occurrence of thrombosis than bleeding. Patients without APA or AVK have less comorbidities, less bleeding and thrombotic events, and better survival. Analytic description of our data is expected to get a risk/benefit ratio of APA and AVK treatment in their different uses. (C) 2015 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.