Impact of chronic kidney disease on the risk of clinical outcomes in patients with cancer-associated venous thromboembolism during anticoagulant treatment.
J Thromb Haemost. 2013 Sep 30;
Authors: Kooiman J, den Exter PL, Cannegieter SC, le Cessie S, Del Toro J, Sahuquillo JC, Pedrajas JM, Huisman MV
Abstract
BACKGROUND: Information on recurrent venous thromboembolic events (VTE) and major bleeding risks during anticoagulant treatment in patients with cancer-associated VTE and chronic kidney disease (CKD) is scarce, although it is of relevance to establish better tailored management strategies in these patients.
OBJECTIVES: We compared risks of recurrent VTE and major bleeds in cancer-associated VTE patients with and without CKD.
METHODS: 1684 patients diagnosed with cancer-associated VTE between 2001-2011 were followed for 180 days after VTE diagnosis. Patients were treated mainly with low-molecular-weight-heparin (LMWH) or vitamin-K antagonists (VKA). Primary outcomes were recurrent VTE and major bleeding. Secondary outcome was fatal bleeding.
RESULTS: Recurrent VTE occurred in 15.9/100 patient years (py) in patients without CKD (eGFR >60 ml/min), 19.5/100 py in those with CKD stage 3A (eGFR 45-60 ml/min), 14.9/100 py in those with CKD 3B (eGFR 30-45 ml/min), and 6.8/100 py in patients with CKD 4-5 (eGFR <30 ml/min). Major bleeding occurred in 11.4/100 py in patients without CKD, 18.5/100 py in those with CKD stage 3A, 16.0/100 py in those with CKD 3B, and 40.8/100 py in patients with CKD 4-5. Fatal bleeding occurred in 1.1/100 py, 3.4/100 py, 6.3/100 py, and 15.7/100 py, respectively. These increased bleeding risks in CKD patients were mainly observed in those on LMWH treatment, not VKA.
CONCLUSIONS: Risk of major bleeding was increased in CKD patients, with VTE and cancer, which was most prominent in those treated with LMWH and an eGFR <30 ml/min. These results indicate that LMWH should be used with caution in this specific population. This article is protected by copyright. All rights reserved.
PMID: 24112123 [PubMed - as supplied by publisher]