Oliver Königsbrügge1, Sabine Schmaldienst2, Martin Auinger3, Renate Klauser-Braun4, Matthias Lorenz5, Susanne Tabernig4, Josef Kletzmayr4, Brigitte Enzenberger3, Manfred Eigner2, Manfred Hecking6, Jolanta M Siller-Matula7, Ingrid Pabinger8, Marcus Säemann9, Cihan Ay8. 1. Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. Electronic address: oliver.koenigsbruegge@meduniwien.ac.at. 2. Department of Medicine I, Kaiser-Franz-Josef-Spital, Vienna, Austria. 3. Department of Medicine III, Hietzing Hospital, Vienna, Austria. 4. Department of Medicine III, Donauspital, Vienna, Austria. 5. Vienna Dialysis Center, Vienna, Austria. 6. Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Austria. 7. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria. 8. Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. 9. Department of Medicine VI, Wilhelminenhospital, Vienna, Austria.
Abstract
BACKGROUND AND AIMS: Cardiovascular disease (CVD) is common in patients with end-stage renal disease (ESRD) on hemodialysis (HD). However, antithrombotic therapy to prevent CVD increases the risk of bleeding. We aimed to investigate the prevalence of CVD and the practice patterns of antithrombotic agents in patients with ESRD on HD. METHODS: In a cross-sectional population based cohort of chronic HD patients (n = 626) from Vienna, Austria, the medical histories of patients and use of antithrombotic treatment were recorded, and the distribution of antithrombotic therapies for primary (n = 260, 41.5%) or secondary (n = 366, 58.5%) prevention of CVD was analyzed. RESULTS: Single antiplatelet therapy (SAPT) was used in 234 patients (37.4%), dual antiplatelet (DAPT) in 50 (8.0%), combination of anticoagulation and antiplatelet in 59 (9.4%), anticoagulation monotherapy in 78 (12.5%), and no antithrombotics in 205 patients (32.7%). The prevalence of CVD was 58.5%. In primary CVD prevention, 23.5% (n = 61) of patients were treated with SAPT. For secondary prevention, SAPT was used in 173 (47.3%), DAPT in 49 (13.4%), and dual antithrombotic therapies in 50 patients (13.7%), while 55 (15.0%) patients received no antithrombotics. Age (odds ratio [OR] per 1 year increase 0.96, 95%CI 0.94-0.99, p = 0.004) and hereditary nephropathy (OR 4.13, 95%CI 1.08-15.78, p = 0.038) were independently associated with the absence of antithrombotic therapy in secondary CVD prevention. CONCLUSION: The majority of patients did not receive antithrombotic therapy for primary prevention. Only 15% did not receive antithrombotic agents in the secondary prevention setting. The net-clinical benefit of antithrombotic therapy in ESRD needs to be determined.
BACKGROUND AND AIMS: Cardiovascular disease (CVD) is common in patients with end-stage renal disease (ESRD) on hemodialysis (HD). However, antithrombotic therapy to prevent CVD increases the risk of bleeding. We aimed to investigate the prevalence of CVD and the practice patterns of antithrombotic agents in patients with ESRD on HD. METHODS: In a cross-sectional population based cohort of chronic HDpatients (n = 626) from Vienna, Austria, the medical histories of patients and use of antithrombotic treatment were recorded, and the distribution of antithrombotic therapies for primary (n = 260, 41.5%) or secondary (n = 366, 58.5%) prevention of CVD was analyzed. RESULTS: Single antiplatelet therapy (SAPT) was used in 234 patients (37.4%), dual antiplatelet (DAPT) in 50 (8.0%), combination of anticoagulation and antiplatelet in 59 (9.4%), anticoagulation monotherapy in 78 (12.5%), and no antithrombotics in 205 patients (32.7%). The prevalence of CVD was 58.5%. In primary CVD prevention, 23.5% (n = 61) of patients were treated with SAPT. For secondary prevention, SAPT was used in 173 (47.3%), DAPT in 49 (13.4%), and dual antithrombotic therapies in 50 patients (13.7%), while 55 (15.0%) patients received no antithrombotics. Age (odds ratio [OR] per 1 year increase 0.96, 95%CI 0.94-0.99, p = 0.004) and hereditary nephropathy (OR 4.13, 95%CI 1.08-15.78, p = 0.038) were independently associated with the absence of antithrombotic therapy in secondary CVD prevention. CONCLUSION: The majority of patients did not receive antithrombotic therapy for primary prevention. Only 15% did not receive antithrombotic agents in the secondary prevention setting. The net-clinical benefit of antithrombotic therapy in ESRD needs to be determined.
Authors: Branka P Mitic; Zorica M Dimitrijevic; Kazuya Hosokawa; Tatjana P Cvetkovic; Milan V Lazarevic; Danijela D Tasic; Andriana Jovanovic; Nina Jancic; Tamara Vrecic; Anna Ågren; Håkan Wallen Journal: Int Urol Nephrol Date: 2022-04-02 Impact factor: 2.266
Authors: Tatiana Yu Salikhova; Denis M Pushin; Igor V Nesterenko; Lyudmila S Biryukova; Georgy Th Guria Journal: PLoS One Date: 2022-10-03 Impact factor: 3.752