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The need for dual antiplatelet therapy following percutaneous coronary intervention (PCI) also imposes a significant bleeding risk. Chronic kidney disease (CKD) is associated with poorer outcomes following PCI, and in addition a detrimental effect on platelet function is well described. In this study the authors investigated the outcomes of patients with chronic renal impairment (defined here as a creatinine clearance [CrCl] <60ml\/min) following PCI.<\/p>\n
In a retrospective study of single centre registry data the authors identified a total of 166 patients who had undergone PCI and had an indication for oral anticoagulation; of these, 68 also had chronic renal impairment (CrCl<60mL\/min). Patients were contacted by telephone to ascertain details about complications and hospital records were also reviewed. Chronic kidney disease was associated with a higher risk for major bleeding (hazard ratio, 3.44; p=0.004) and all-cause mortality (hazard ratio, 3.50; p=0.003). Noticeably, triple antithrombotic therapy (aspirin, clopidogrel, and warfarin) was associated with a significantly increased risk for a major bleeding complication (hazard ratio, 3.29; p=0.043), regardless of renal function.<\/em><\/p>\n While this small study suffers from the problems associated with all retrospective studies it is a useful reminder of the hazards associated with extended periods of antiplatelet and anticoagulant therapy in patients with multiple co-morbidities. In addition, it reminds us that using warfarin with dual anti-platelet therapy more than triples the risk of major bleeding.<\/p>\n