Specialized Management of Oral Anticoagulation Therapy Improves Outcome in Patients with Chronic Renal Insufficiency

Oral anticoagulation (OAC) is effective at preventing and treating thromboses and thromboembolism in patients with normal renal function. We aimed to research the impact of severe renal failure (RF) on patient outcome and to determine the potential benefit of caring for these patients in a specializ...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical medicine 2020-02, Vol.9 (3), p.645
Main Authors: Lauterbach, Michael, Uhrich, Eduard, Eggebrecht, Lisa, Göbel, Sebastian, Panova-Noeva, Marina, Nagler, Markus, Ten Cate, Vincent, Bickel, Christoph, Espinola-Klein, Christine, Münzel, Thomas, Wild, Philipp S, Prochaska, Jürgen H
Format: Article
Language:English
Subjects:
Anticoagulants
Cardiac arrhythmia
Cardiovascular disease
Clinical medicine
Clinical trials
Creatinine
Embolisms
Hemorrhage
Mortality
Stroke
Thromboembolism
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Oral anticoagulation (OAC) is effective at preventing and treating thromboses and thromboembolism in patients with normal renal function. We aimed to research the impact of severe renal failure (RF) on patient outcome and to determine the potential benefit of caring for these patients in a specialized coagulation service (CS). A total of 1516 usual medical care patients and 756 CS-managed patients of the thrombEVAL multicenter (21 centers), prospective, cohort study (NCT01809015) were analyzed in a 3-year follow-up. Patients with RF (serum creatinine >3 mg/dL, no renal replacement therapy) were compared to patients without RF in usual care and a CS. The fluctuations in the international normalized ratios were significantly lower in CS-managed patients, and regardless of treatment in usual care or a CS, the time in therapeutic range was significantly lower in RF patients. Cox regression-adjusted hazard ratios for long-term outcome (1.5, 95% CI: 1.22-1.83, < 0.001), death (1.62, CI: 1.27-2.08, < 0.001), and hospitalization (1.21, CI: 1.02-1.44, = 0.032) were significantly higher in RF patients in usual care. Furthermore, there was a trend of more bleeding events in RF patients. CS-treated patients had significantly lower adjusted hazard ratios for death (0.24, CI: 0.14-0.39, < 0.001), hospitalizations (0.41, CI: 0.34-0.5, < 0.001), clinically relevant bleeding (0.29, CI: 0.18-0.47, < 0.001), and major bleeding (0.33, CI: 0.18-0.59, < 0.001). Thus, patients who required oral anticoagulation therapy benefitted significantly from being managed in a specialized coagulation service, regardless of their renal function.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9030645