Abstract
Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis. This study aimed to evaluate the bleeding risk with CKD patients undergoing pentoxifylline (PTX) treatment with/without aspirin. In this retrospective study, we used Taiwan’s National Health Insurance Research Database to identify PTX treated CKD patients. Patients undergoing PTX treatment after CKD diagnosis were PTX group. A 1:4 age, sex and aspirin used condition matched CKD patients non-using PTX were identified as controls. The outcome was major bleeding event (MBE: intracranial haemorrhage (ICH) and gastrointestinal tract bleeding) during 2-year follow-up period. Risk factors were estimated using Cox regression for overall and stratified analysis. The PTX group had higher MBE risk than controls (hazard ratio (HR) 1.19; 95% confidence interval (CI) 0.94–1.50). In stratified analysis, hyperlipidaemia was a significant risk factor (HR: 1.42; 95% CI 1.01–2.01) of MBE. A daily PTX dose larger than 800 mg, females, non-regular aspirin usage, and ischaemic stroke were risk factors for MBE in PTX group. When prescribing PTX in CKD patients, bleeding should be closely monitored, especially in those with daily dose more than 800 mg, aspirin users, and with a history of ischaemic stroke.
Highlights
Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis
After applying the exclusion criteria, 1020 patients treated with PTX were selected as the study group (PTX group) and 1:4 age, gender, and aspirin use condition matched patients were chosen as the control group (Fig. 1)
The proportions of patients with diabetes mellitus (DM), hypertension, hyperlipidaemia, and a history of ischaemic stroke were significantly higher in the PTX (P < 0.0001) whereas the proportion of patients with end-stage renal disease (ESRD) was significantly less than the control group (30 vs. 204, P = 0.0049)
Summary
Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis. This study aimed to evaluate the bleeding risk with CKD patients undergoing pentoxifylline (PTX) treatment with/without aspirin. In this retrospective study, we used Taiwan’s National Health Insurance Research Database to identify PTX treated CKD patients. The current pharmacological agents with strong evidences to control CKD are renin–angiotensin–aldosterone-system inhibitors and sodium glucose cotransporter 2 inhibitors The PTX metabolite M5 that contribute to the hemorheological effects accumulates when the renal function is severely impaired[17] Under such complicated interference from these conditions, the risk of bleeding due to PTX alone or in combination with aspirin in CKD patients is our concern. The present study aimed to elucidate this bleeding risk in CKD patients
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