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Original Research: ANTITHROMBOTIC THERAPY |

Impact of Chronic Kidney Disease on Major Bleeding Complications and Mortality in Patients With Indication for Oral Anticoagulation Undergoing Coronary Stenting

Sergio Manzano-Fernández, MD; Francisco Marín, MD, PhD; Francisco J. Pastor-Pérez, MD; Cesar Caro, MD; Francisco Cambronero, MD, PhD; Javier Lacunza, MD; Eduardo Pinar, MD, PhD; Domingo A. Pascual-Figal, MD, PhD; Mariano Valdés, MD, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

*From the Department of Cardiology (Drs. Manzano-Fernández, Marín, Pastor-Pérez, Caro, Cambronero, Lacunza, Pinar, Pascual- Figal, and Valdés), University Hospital Virgen de la Arrixaca, Murcia, Spain; and University Department of Medicine (Dr. Lip), City Hospital, Birmingham, UK.

Correspondence to: Gregory Y. H. Lip, MD, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK; e-mail: g.y.h.lip@bham.ac.uk


The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):983-990. doi:10.1378/chest.08-1425
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Background:  Patients with indications for oral anticoagulation (OAC) undergoing percutaneous coronary artery stenting (PCI-S) represent a high-risk population for major bleeding complications. Chronic kidney disease (CKD) is also associated with poor outcome after PCI-S. Limited data are available regarding the impact of CKD on the frequency of major bleeding and mortality in this population.

Methods:  We investigated the influence of CKD on major bleeding and all-cause mortality in patients with indication for OAC who undergo PCI-S. Patients were grouped according to calculated creatinine clearance (CrCl): CrCl > 60 mL/min, (n = 98) and CrCl ≤ 60 mL/min, (n = 68). Major bleeding and major adverse vascular events (all-cause mortality, myocardial infarction, repeat revascularization, stent thrombosis, or stroke) were collected during follow-up.

Results:  We analyzed 166 consecutive patients with indication(s) for OAC (77% men; mean age, 71 years; range, 66 to 76 years) after undergoing PCI-S. CKD was associated with higher risk for major bleeding (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.50 to 7.93; p = 0.004) and all-cause mortality (HR, 3.50; 95% CI, 1.53 to 7.99; p = 0.003). In multivariate analyses, age > 75 years (HR, 2.75; 95% CI, 1.15 to 6.56; p = 0.023), CKD (HR, 2.59; 95% CI, 1.00 to 6.95; p = 0.049), anemia (HR, 2.36; 95% CI, 1.00 to 5.54; p = 0.049), and triple antithrombotic therapy (HR, 3.29; 95% CI, 1.23 to 8.84; p = 0.018) were independent predictors for major bleeding, whereas age > 75 years (HR, 2.38; 95% CI, 1.03 to 5.59; p = 0.046) and CKD (HR, 2.44; 95% CI, 1.03 to 5.82; p = 0.044) were predictors for all-cause mortality.

Conclusion:  In this high-risk population, CKD is independently associated with increased major bleeding and all-cause mortality following PCI-S.

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