Abstract: TH-PO1053
Anticoagulation and Anti-Platelet Prescribing in Glomerular Disease: An Observational Study
Session Information
- Glomerular Diseases: Epidemiology, Mechanisms, Complications, Outcomes
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Doan, Joseph, Harbor UCLA, Torrance, California, United States
- Kamil, Elaine S., Cedar-Sinai Medical Center, Los Angeles, California, United States
- Vintch, Janine R. e., Harbor-UCLA Medical Center, Torrance, California, United States
- Gipson, Debbie S., University of Michigan Mott Children's Hospital, Ann Arbor, Michigan, United States
- Dai, Tiane, Harbor UCLA, Torrance, California, United States
- Elliott, Matthew, Metrolina Nephrology Associates, Charlotte, North Carolina, United States
- Tong, Lili, LABiomedical Research Institute at Harbor-UCLA, Torrance, California, United States
- O'Shaughnessy, Michelle M., Stanford University, Palo Alto, California, United States
- La page, Janine A., Los Angeles Biomedical Research Institute, Torrance, California, United States
- Massengill, Susan F., Levine Children's Hospital, Charlotte, North Carolina, United States
- Chen, Liz Yao, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States
- Gipson, Patrick E., University of Michigan, Ann Arbor, Michigan, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
Background
Nephrotic syndrome confers thromboembolism (TE) risk. We report frequencies of TE and anticoagulation (AC) and antiplatelet (AP) prescribing in patients with/without nephrotic-range proteinuria enrolled in Nephcure Kidney Research Network (KRN) Registry.
Methods
Patients with glomerular disease (GD) from all KRN sites were included. Encounter, diagnosis, meds, lab, and vital sign data were extracted monthly from patients’ EMRs. Patients were grouped into those with at least one UPCR >3.5 g/g (Nephrotic) vs those with UPCR always <3.5 g/g (Non-nephrotic). TE and AC/AP prescription (Rx) frequencies were determined. Follow-up was censored at ESRD.
Results
Nephrotic (n=568) and Non-nephrotic (n=404) groups were similar in age/sex. Mean eGFR (93 vs. 70 ml/min/1.73m2, p<.001) and UPCR (4.9 vs. 0.7 g/g, p<.001) were higher, and serum albumin lower (3.1 vs. 3.9 g/dL, p<.001) in Nephrotics vs. Non-nephrotics. Nephrotics and Non-nephrotics had: FSGS/C1Q (59% vs 41%); Minimal change/IgM/MesPGN (77% vs 23%); Membranous (79% vs 21%), IgA (28% vs 7%), or other GD (54% vs 46%). 90 Nephrotics and 52 Non-nephrotics had no biopsy (mostly children). Median follow-up for Nephrotics (57 mos) was longer than Non-nephrotics (49)(p<.001). There were 70 TE: 9.2% of Nephrotics (n=52) vs 4.5% of Non-nephrotics (n=18)(p<.005). AC/AP Rxs were more frequent in Nephrotics (203 of 568, 36%) than Non-nephrotics (67 of 404, 17%)(p<.0001). The 203 Nephrotics had AC/AP Rx as follows: heparin, enoxaparin, fondaparinux (64%); aspirin (58%); warfarin (11%); alteplase, urokinase (9%); Factor Xa inhibitors (Xai, 5%); and/or clopidogrel, ticagrelor (4%). Non-nephrotics (n=67) had heparin, enoxaparin, fondaparinux (46%, p<.0001 vs Nephrotics); aspirin (61%); warfarin (12%); alteplase, urokinase (9%); Xai (6%); and/or clopdiogrel, prasugrel, dipyriadamole (9%).
Conclusion
In KRN, TE and AC/AP prescriptions were twice as frequent in Nephrotics than Non-nephrotics. Heparin/congeners were prescribed 6 times more often than warfarin in Nephrotics; 3 times more often in Non-nephrotics. Aspirin was prescribed frequently and Xai infrequently in both groups. These variable practices suggest a need for further exploration of AC/AP indications/efficacy/ safety in GD patients.
Funding
- Private Foundation Support