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CKD 'doubles anticoagulant bleeding risk'

Patients with chronic kidney disease have more than double the risk of bleeding from anticoagulation therapy compared with patients without CKD, according to Danish researchers.

Their study looked at over 132,000 patients discharged from hospital with a diagnosis of atrial fibrillation over 12 years and found 3% had non end-stage CKD.

They then determined the patients' pharmacotherapy using filled prescriptions for medications and found those with CKD had more than twice the risk of bleeding if they took anticoagulants, compared with patients who had no renal disease.

Patients that required renal-replacement therapy had more than twice the risk of bleeding when taking anticoagulants, compared with patients without CKD.

In patients with any renal disease, the combination of warfarin plus aspirin was found to produce the highest risk of bleeding, at 61%, compared with patients without renal disease. Warfarin alone was next at 33%, with aspirin alone at 17%. All differences in risk were significant.

The researchers concluded: ‘The net clinical effect of warfarin treatment requires careful assessment in patients with chronic kidney disease. Certainly, close monitoring of the normalised ratio is required when warfarin is administered.'

N Eng J Med 2012, online 16 August

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