Among patients with venous thromboembolism (VTE), those with co-existing moderate to severe chronic kidney disease (CKD) have increased risks for death, VTE recurrence, and major bleeding compared with those with mild or no CKD, despite use of anticoagulant therapy.
In the GARFIELD-VTE study (Global Anticoagulant Registry in the Field – Venous Thromboembolism), investigators compared 12-month outcomes between 2055 patients with stage 3 to 5 CKD and 6924 patients with stage 1 to 2 (mild CKD) or no CKD, defined by the Modification of Diet in Renal Disease (MDRD) equation. VTE occurred in similar proportions of both groups. Deep vein thrombosis (DVT) alone developed in 57.0% of patients with moderate to severe CKD and 58.9% with mild to no CKD. Pulmonary embolism (PE) alone occurred in 26.6% vs 24.9%, respectively. Concurrent DVT and PE manifested in 16.4% vs 16.2%, respectively.
Patients with moderate to severe CKD had significant 44%, 40%, and 40% increased risks for all-cause mortality, major bleeding, and recurrent VTE, respectively, over 12 months in adjusted analyses, compared with patients with mild or no CKD, Shinya Goto, MD, PhD, of Tokai University School of Medicine in Kanagawa, Japan, and colleagues reported in JAMA Network Open. More patients with moderate to severe CKD were older than 65 years (62.2% vs 33.4%) and female (57.1% vs 47.1%) and had heart failure (6.7% vs 2.2%), they observed. Having proximal vs distal DVT was associated with higher death and recurrence risks. The most frequent sites of major bleeding were the upper and lower gastrointestinal tract.
With respect to baseline anticoagulation, parenteral anticoagulation treatment alone was used comparably in patients with moderate to severe CKD vs mild or no CKD. Patients with moderate to severe CKD were more likely to receive vitamin K antagonist (VKA) therapy, either alone or in combination with parenteral therapy, and less likely to receive direct oral anticoagulant therapy (DOAC), either alone or in combination with parenteral therapy.
“A higher incidence of bleeding events in patients with moderate to severe CKD raises the question of whether the intensity of anticoagulant medication currently being used is too high,” Dr Goto’s team wrote.
Disclosure: This clinical trial was supported by Bayer Pharma AG. Please see the original reference for a full list of authors’ disclosures.
Goto S, Haas S, Ageno W, et al. Assessment of outcomes among patients with venous thromboembolism with and without chronic kidney disease. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.22886