Research published in the journal BMC Medicine investigates the impact of kidney function in patients on antithrombotic therapy.
The study, a post hoc sub-group analysis focusing on recurrent bleeding events in the AFIRE (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) trial, concluded that patients should have detailed discussions with physicians regarding the possible bleeding events when continuing antithrombotic therapy, especially in patients with decreased kidney function.
The analysis, by researchers at Kumamoto, Miyazaki, and Tohoku Universities in Japan, revealed that the effect of kidney function on recurrent bleeding risk events was quite large for patients undergoing this treatment. They also found that the bleeding risk decreased with time for patients with healthy kidney function but remained high for patients with decreased kidney function. Clearly, the decision to use such a therapy should be balanced between the expected antithrombotic effects and bleeding risks, the authors suggest.
In most cases, it is considered better to continue antithrombotic therapies even after bleeding events as long as the event was not severe. However, they claim that it is not surprising that both patients and physicians hesitate to continue the therapy after any bleeding event.
To assess for drug safety and efficacy, these drugs are usually measured by the numbers of bleeding and thrombotic events. Unfortunately, the authors note, in the assessment of antithrombotic therapy, most studies only consider the first event in their analyses even though patients could experience multiple events throughout their lifetime.
This study revealed that the impact of kidney function on bleeding risk during antithrombotic therapy is larger than estimated in previous studies. Furthermore, patients with healthy kidney function appear to have a decreased risk of experiencing a bleeding event over time, but the risk for patients with reduced kidney function remains high as time continues.
“A detailed discussion between patients and physicians based on all current scientific evidence about the risks and benefits of antithrombotic therapy is highly recommended,” said study leader Kunihiko Matsui of Kumamoto University Hospital’s Department of General Medicine and Primary Care. “Our analysis should be quite useful in facilitating this type of discussion.”