Original InvestigationPathogenesis and Treatment of Kidney DiseaseVenous Thromboembolism in Patients With Reduced Estimated GFR: A Population-Based Perspective
Section snippets
Study Design, Sampling, and Data Abstraction
The Worcester Venous Thromboembolism Study is an ongoing population-based surveillance study examining the descriptive epidemiology of VTE, including its magnitude, prophylaxis, and management strategies; in-hospital and post-discharge outcomes; and long-term recurrence, bleeding, and all-cause mortality rates, in residents from a large central New England metropolitan area.1, 2, 14 The catchment area for this study included all 12 hospitals serving residents of the Worcester, MA, standard
Demographic and Clinical Characteristics
Of 1,509 patients with confirmed VTE, 122 had eGFR <30 mL/min/1.73 m2, 432 had eGFR of 30-59 mL/min/1.73 m2, 575 had eGFR of 60-89 mL/min/1.73 m2, and the rest (n = 380) had eGFR ≥90 mL/min/1.73 m2. The prevalence of decreased eGFR (<60 mL/min/1.73 m2) in our total study sample essentially was similar across the 3 study years; 37.7% of patients had decreased eGFR in 1999; 36.8%, in 2001; and 35.7%, in 2003 (P = 0.8). At initial VTE presentation, deep vein thrombosis was most common in patients
Discussion
The incidence and prevalence of kidney disease have nearly doubled during the past decade, presently affecting more than 20 million Americans.18, 19, 20 Given the increasing magnitude of this disease, the frequency with which these patients are hospitalized, and increased bleeding risk associated with most anticoagulants, better understanding of the clinical profile, current management, and outcomes of patients with decreased kidney function who are at risk of and/or develop VTE is needed.
In
Acknowledgements
Support: This research study is supported by a grant from the National Heart, Lung, and Blood Institute (R01-HL70283). Dr Spencer is supported by a Career Investigator Award from the Heart and Stroke Foundation of Ontario.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism
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2018, Design StudiesCitation Excerpt :In the situation of renal insufficiency, the physiopathological mechanisms of hemostasis are complex and diverse and they lead to an imbalance coagulation/fibrinolysis equilibrium involving oxidative stress and inflammation [1–4]. Patients with renal insufficiency have a higher risk of both venous thrombosis, and bleeding [5,6]. This cumulative over-risk represents a two-fold constraint, making an anticoagulation treatment difficult to manage in CKD patients [7].
Originally published online August 29, 2011.