NO EVIDENCE FOR AN ASSOCIATION BETWEEN RENAL FUNCTION AND BLEEDING EVENTS IN PATIENTS ON COUMARIN THERAPY- A POPULATION-BASED STUDY
Author(s)
Houben E1, Smits E1, Overbeek JA2, Herings RM1, Van Herk-Sukel MP1, Teichert M3, de Smet PA4
1PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands, 2VU University Medical Centre, Amsterdam, The Netherlands, 3Royal Dutch Pharmacists Association (KNMP), Den Haag, NV, The Netherlands, 4Radboud University Medical Centre, Nijmegen, The Netherlands
OBJECTIVES: Although anticoagulation therapy is closely monitored by regional anticoagulation clinics in the Netherlands, coumarin induced over-anticoagulation is still observed and associated with serious bleeding events. Current literature suggests that these medication-related hospital admissions might be due to renal impairment. The objective was to explore the association between renal function and bleeding events in patients on coumarin therapy. METHODS: A nested case-control study was conducted using data from the PHARMO Database Network, a population-based network in the Netherlands combining data from different healthcare settings. Patients hospitalised for bleeding events during coumarin therapy were selected as cases and matched to up to 2 controls using coumarins without hospitalisation for bleeding. The hospitalisation date of the cases was set as index date and controls were assigned the index date of their matched case. As a proxy for renal function, all values of estimated glomerular filtration rates (eGFR) calculated from serum creatinine laboratory test results were selected in the 12 months before the index date. These were compared between cases and controls using logistic regression analyses. RESULTS: In total, 2,066 cases cases hospitalised for bleeding events during coumarin therapy (60% male, mean±SD age 74±11 years) were matched to 4,082 controls without hospitalisation for bleeding (60% male, mean±SD age 78±11 years). No association was found between the mean eGFR value in the 12 months before index and bleeding events (mean±SD 65.9±22.8 vs. 65.0±20.9 ml/min/1.73m2; OR 1.01, 95% CI 1.00-1.01). Overall, the availability of eGFR values was higher among cases in the 12 months before index (mean±SD 4.4±6.9 vs. 3.3±5.4 eGFR values), reflected in the significantly shorter time since last eGFR value (at index date) (mean±SD 2.6±2.9 vs. 3.7±3.1 months; OR 0.91, 95% CI 0.89-0.93). CONCLUSIONS: No association between renal function and bleeding events during coumarin therapy was observed.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCV3
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Cardiovascular Disorders