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Journal de Pharmacie Clinique

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Risk of antivitamin K and antiplatelets agents association in hemodialysis patients Volume 33, issue 2, Juin 2014

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Authors
Calydial, Centre hospitalier Lucien Hussel, Vienne, France
* Tirés à part

Hemodialysis patients have an increased risk of bleeding, responsible for increased morbidity and mortality. Discordance studies on the risk/benefit ratio of vitamins K antagonist (VKA) in hemodialysis patients, associated or not with platelet aggregation inhibitors invited us to pursue investigations on the subject. In order to overcome the heterogeneity of INR targets of our population due to different indications of VKA, we chose to evaluate 2 groups of patients according to the target of INR (≥2.5 and <2.5). This value is the cutoff for preventive anticoagulation for low embolic risk diseases (INR <2.5) and high embolic risk diseases (INR ≥2.5). Patients in the group of target INR <2.5 presented more difficulties to maintain the INR values in the target. The results were consistent with previous data in the literature claiming that the VKA association with platelet aggregation inhibitors increased the risk of bleeding events. The VKA association with platelet aggregation inhibitors generated an increased risk of adverse events, which is not reduced by the choice of a low INR target. Whatever the INR target was, hemorrhagic stroke are very common with the addition of platelet aggregation inhibitors, therefore the choice of a combined prescription must be carefully initiated in hemodialysis patients.