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Bleeding Risk of Antithrombotic Treatment in Patients on Hemodialysis

Vázquez, Eduardo MD, PhD; Sánchez-Perales, Carmen MD, PhD; Ortega, Sonia MD; Vázquez-Sánchez, Teresa MD; Quesada, Enrique MD; Salas, Daniel MD, PhD; Fernández-Guerrero, Juan Carlos MD

Journal of Cardiovascular Pharmacology: April 2017 - Volume 69 - Issue 4 - p 192–197
doi: 10.1097/FJC.0000000000000460
Original Article

Background: The risk–benefit of antithrombotic treatment (ATT) has not been established in patients on dialysis. Our objective was to determine the influence of ATT on the risk of hemorrhage in patients on hemodialysis.

Methods: We included patients who began dialysis between 2003 and 2007. We determined the rates of fatal bleeding or bleeding leading to hospitalization or transfusion.

Results: Two hundred twenty-one patients were included. Over the follow-up period (45.5 ± 34 months), there were 76 hemorrhages in 52 patients. There were 10 fatal bleedings. The annual incidence of patients presenting with hemorrhagia was 6.2%. Bleeding occurred in 5.2% of those being treated with aspirin, 7% with acenocumarol, 12.3% with clopidogrel, 15.2% with aspirin + clopidogrel, 45.9% with anticoagulants + antiplatelets, 49.6% with low-molecular-weight heparin, and 3.9% without ATT. On multivariate analysis, masculine gender [hazard ratio (HR): 2.421; 95% confidence interval (CI), 1.261–4.650; P = 0.003], treatment with dicumarins (HR: 2.406; 95% CI, 1.013–5.718; P = 0.047), treatment with clopidogrel (HR: 2.697; 95% CI, 1.440–5.051; P = 0.002), and treatment with low-molecular-weight heparin (HR: 21.463; 95% CI, 9.067–50.806; P = 0.001) were independent predictors of bleeding.

Conclusions: ATT increases the risk of bleeding in patients on hemodialysis. The incidence of hemorrhage varies with the type of antithrombotics used.

*Unidad de Gestión Clínica de Cardiología, Complejo Hospitalario de Jaén, Jaén, Spain;

Unidad de Gestión Clínica de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain; and

Servicio de Nefrología, Hospital Regional Universitario de Málaga, Málaga, Spain.

Reprints: Eduardo Vázquez, MD, PhD, Complejo Hospitalario de Jaén, Cardiology Avda del Ejército Español s/n, 23007 Jaén, Spain (e-mail:

The authors report no conflicts of interest.

Received August 30, 2016

Accepted December 12, 2016

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