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Kidney Week

Abstract: TH-PO256

Anticoagulant and Antiplatelet Use and Risk of Serious Bleeding Events Among PDOPPS and DOPPS Patients Receiving Peritoneal or Hemodialysis, 2009-2022

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Coyle, Catelyn, Merck & Co Inc, Rahway, New Jersey, United States
  • Bash, Lori D., Merck & Co Inc, Rahway, New Jersey, United States
  • Ramey, Dena Rosen Rosen, Merck & Co Inc, Rahway, New Jersey, United States
  • Atkins, Brandon, Merck & Co Inc, Rahway, New Jersey, United States
  • Barash, Irina, Merck & Co Inc, Rahway, New Jersey, United States
  • Guedes, Murilo Henrique, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Zhao, Junhui, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Bonaca, Marc P., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
Background

Risk of serious bleeds among patients receiving dialysis is higher than the general population and may increase with the use of oral anticoagulant (OAC) and antiplatelet therapies (APT). The rate of bleeding in patients on OAC and APT between dialysis modalities are not well reported.

Methods

Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS; 2009-2022) and Peritoneal DOPPS (PDOPPS; 2014-2022), we describe OAC and APT use among patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and present event rates of bleeding events that led to death or inpatient hospitalization, per 100 person-years, stratified by dialysis type, and use of OAC or APT.

Results

Overall, 27,612 received HD and 5,288 PD. OAC (9% vs. 4%) and APT (10% vs. 7%) use was higher among patients receiving HD vs. PD, and >99% of all OAC use was warfarin. In both modalities, the rates of non-fatal, fatal bleeding events and hospitalizations due to any bleed or GI bleed were higher for patients prescribed (vs. not) OAC and APT (Table). First hospitalization bleeding rates occurred 2 and 3 times more often among HD patients and PD patients using OACs (compared to not), respectively. Those using APTs were observed to have a 25% (HD) and 40% (PD) increase (compared to not) in first hospitalization rate. The same trend was observed for recurrent hospitalizations due to any bleed and fatal bleeds.

Conclusion

OAC and APT use was ≤10% in both populations. Serious bleeding rates were higher among patients prescribed OAC and APT regardless of dialysis modality and differences in bleeding rates between treatment groups were larger among PD patients. Results underscore the need for strategies to reduce bleeding in patients on dialysis requiring anticoagulation, including novel agents with improved safety profiles.

Funding

  • Commercial Support – Merck and Co., Inc.