PB0521 - Use of antithrombotic agents for the prevention of coronary and peripheral arterial events in patients with end-stage kidney disease on hemodialysis: Prospective results of the VIVALDI study

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Oliver Königsbrügge, MD PhD

Physician Scientist
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Co-Author(s)

ML

Matthias Lorenz

Medical Doctor
Vienna Dialysis Center, Vienna, Austria
Vienna, Wien, Austria
SS

Sabine Schmaldienst

Medical Doctor
Department of Medicine I, Clinic Favoriten
Vienna, Wien, Austria
RK

Renate Klauser-Braun

Medical Doctor
Department of Medicine III, Clinic Donaustadt
Vienna, Wien, Austria
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
MS

Marcus Säemann

Medical Doctor
Department of Medicine VI, Clinic Ottakring
Vienna, Wien, Austria
Cihan Ay, MD

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Antithrombotic agents are frequently used medications in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), because indications including atrial fibrillation, coronary heart disease and peripheral artery disease are highly prevalent in ESKD, although evidence on efficacy and safety is scarce. Vitamin-K-antagonists (VKA) are, however, suspected of accelerating vascular calcification and increasing the risk for arterial cardiovascular outcomes.

Aims: We aimed to investigate the incidence of arterial outcomes in HD patients and the association with antiplatelet agents and VKA treatment.

Methods: A cohort of 625 patients with ESKD on HD was prospectively observed for a median observation time of 3.4 years (25th to 75th percentile 2.9-3.5 years) and occurrence of arterial outcomes were recorded and independently adjudicated. Participation in the study was confirmed with informed consent and with the approval of the local ethics committee. The occurrence of death was considered in competing risk regression.

Results: Absolute frequency of coronary and peripheral artery outcomes and incidence rates are presented in table 1.
Use of antiplatelet agents in secondary cardiovascular disease (CVD) prevention (N=276 out of 367 patients with prior cardiovascular disease) was not statistically significantly associated with occurrence of arterial outcomes (table 2).
Use of VKA in AF patients (N=99 out of 238 patients with AF) was associated with increased risk of the composite outcome of peripheral artery revascularizations, acute limb ischemia, and any amputations (HR 1.81, 95% confidence interval 1.04-3.16, p=0.035) after adjustment for prior ischemic stroke, coronary artery disease, and peripheral artery disease (table 2).

Conclusion(s): Coronary and peripheral artery events are common cardiovascular events in HD patients. Neither VKA in AF patients nor antiplatelet agents in secondary CVD prevention was associated with reduced risk of outcomes, but use of VKA may be associated with increased risk of peripheral artery outcomes, albeit a potential confounding by indication remains.