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Kidney Week

Abstract: TH-PO1142

Optimal Treatment for Prevention of Recurrent Thrombosis After Idiopathic Renal Infarction

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Khayat, Maurice I., Walter Reed National Military Medical Center, Vienna, Virginia, United States
  • Olson, Stephen W., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Vienna, Virginia, United States
Background

Idiopathic renal infarction (iRI) is rare but associated with significant morbidity. Recurrent episodes of systemic thrombosis have been reported after diagnosis. Anticoagulation and antiplatelet therapy have been previously described, but no prior studies have established an optimal treatment regimen following iRI.

Methods

We performed a retrospective cohort study of 104 iRI cases (2003-2018) confirmed by review of the military electronic medical record (EMR). iRI was defined by the absence of cardioembolic, hypercoagulable or vasculopathy risk factors. The cases were divided into groups receiving (n=48) and not receiving (n = 56) anticoagulation therapy. The non-anticoagulation group was further divided into antiplatelet (n=37) and no therapy (n=19) subgroups. All cases were reviewed for evidence of the primary outcomes of recurrent arterial thrombosis, de novo venous thrombosis, and bleeding events over the maximum duration of follow up available in the EMR.

Results

Median follow up was 53 months (IQR 27-99) following iRI. There was no significant difference in the incidence of recurrent arterial thrombosis between the anticoagulation group and the non-anticoagulation group [4% (2/48) vs. 0% (0/56), p =0.21] or between the anticoagulation group and the antiplatelet subgroup [4% (2/48) vs. 0% (0/37), p =0.50]. There was also no significant difference in the incidence of de novo venous thrombosis (different cases than arterial thrombosis) between the anticoagulation group and the non-anticoagulation group [4% (2/48) vs. 0% (0/56), p =0.21] or between the anticoagulation group and the antiplatelet subgroup [4% (2/48) vs. 0% (0/37), p =0.50]. More iRI patients in the anticoagulation group had a bleeding event than both the non-anticoagulation [13% (6/48) vs. 0% (0/56), p=0.008] and antiplatelet [13% (6/48) vs. 0% (0/37), p=0.03] subgroups.

Conclusion

Anticoagulation after iRI is not associated with a reduction in either recurrent arterial thrombosis or de novo venous thrombosis, but is associated with an increased risk of bleeding. This study suggests that antiplatelet agents may be the best treatment option following iRI, but further evaluation is warranted in a randomized study.

Funding

  • Other U.S. Government Support