Mild kidney disease as a risk factor for major bleeding in patients with atrial fibrillation undergoing percutaneous coronary stenting

Sergio Manzano-Fernández; Francisco Cambronero; Cesar Caro-Martínez; Jose A. Hurtado-Martínez; Francisco Marín; Francisco J. Pastor-Pérez; Alicia Mateo-Martínez; Marianela Sánchez-Martínez; Eduardo Pinar-Bermúdez; Mariano Valdés

doi:10.1160/TH11-08-0524

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(01): 51-58
DOI: 10.1160/TH11-08-0524

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Mild kidney disease as a risk factor for major bleeding in patients with atrial fibrillation undergoing percutaneous coronary stenting

Sergio Manzano-Fernández

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Francisco Cambronero

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Cesar Caro-Martínez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Jose A. Hurtado-Martínez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Francisco Marín

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Francisco J. Pastor-Pérez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Alicia Mateo-Martínez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Marianela Sánchez-Martínez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Eduardo Pinar-Bermúdez

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

,

Mariano Valdés

¹Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain

› Author Affiliations

Abstract

Summary

Bleeding risk is increased in patients with atrial fibrillation (AF) and moderate to severe kidney disease (KD); however, the implication of mild KD on bleeding remains unclear. The aim of this study was to determine whether the presence of mild KD increases risk for major bleeding (MB) in patients with AF undergoing percutaneous coronary intervention with stent implantation (PCI-S). Two hundred eighty-five patients were included. Patients were classified into three kidney function groups: moderate to severe KD (n=91; <60 ml/min/1.73 m²), mild KD (n=139; 60–89 ml/min/1.73 m²) and non-KD (n=55; ≥90 ml/min/1.73 m²). Estimated glomerular filtration rate was calculated using the simplified Modification of Diet in Renal Disease equation. Patients were followed for one year, and the occurrence of MB was obtained in all. A total of 28 patients (9.8%) presented MB. MB complications examined as a function of KD groups revealed that there was a graded increase in MB with worsening renal function (non KD=1.8%, mild KD=7.9%, moderate to severe KD=17.6%; p <0.001). Multivariable Cox regression analysis showed that mild KD was associated with nearly a 2.5-fold (2.43 95% confidence interval 1.11–5.34, p=0.039) increase in the risk of MB as compared with non-KD patients. Other independent predictors of MB were moderate-severe KD, anaemia and triple antithrombotic therapy after PCI-S (C-index=0.76). In this population, mild KD confers a significantly increase in the risk for MB complications. Future studies should assess the potential role of incorporating mild KD into the bleeding risk scales to improve the stratification of these patients.

Keywords

Kidney disease - bleeding - atrial fibrillation - coronary stenting

Full Text

References

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