Predictive Value of HAS-BLED Score Regarding Bleeding Events and Graft Survival following Renal Transplantation

Medientyp: E-Artikel

Titel: Predictive Value of HAS-BLED Score Regarding Bleeding Events and Graft Survival following Renal Transplantation

Beteiligte: Hau, Hans Michael [VerfasserIn]; Eckert, Markus [VerfasserIn]; Laudi, Sven [VerfasserIn]; Völker, Maria Theresa [VerfasserIn]; Stehr, Sebastian [VerfasserIn]; Rademacher, Sebastian [VerfasserIn]; Seehofer, Daniel [VerfasserIn]; Sucher, Robert [VerfasserIn]; Piegeler, Tobias [VerfasserIn]; Jahn, Nora [VerfasserIn]

Erschienen: Basel: MDPI, [2023]

Sprache: Englisch

Schlagwörter: anticoagulation ; kidney transplantation ; antiplatelet therapy ; cardiovascular disease ; HAS-BLED score

Entstehung:

Anmerkungen:

Beschreibung: Objective: Due to the high prevalence and incidence of cardio- and cerebrovascular diseasesamong dialysis-dependent patients with end-stage renal disease (ERSD) scheduled for kidneytransplantation (KT), the use of antiplatelet therapy (APT) and/or anticoagulant drugs in this patientpopulation is common. However, these patients share a high risk of complications, either due tothromboembolic or bleeding events, which makes adequate peri- and post-transplant anticoagulationmanagement challenging. Predictive clinical models, such as the HAS-BLED score developed forpredicting major bleeding events in patients under anticoagulation therapy, could be helpful tools forthe optimization of antithrombotic management and could reduce peri- and postoperative morbidityand mortality. Methods: Data from 204 patients undergoing kidney transplantation (KT) between2011 and 2018 at the University Hospital Leipzig were retrospectively analyzed. Patients werestratified and categorized postoperatively into the prophylaxis group (group A)—patients withoutpretransplant anticoagulation/antiplatelet therapy and receiving postoperative heparin in prophylacticdoses—and into the (sub)therapeutic group (group B)—patients with postoperative continueduse of pretransplant antithrombotic medication used (sub)therapeutically. The primary outcomewas the incidence of postoperative bleeding events, which was evaluated for a possible associationwith the use of antithrombotic therapy. Secondary analyses were conducted for the associations ofother potential risk factors, specifically the HAS-BLED score, with allograft outcome. Univariate andmultivariate logistic regression as well as a Cox proportional hazard model were used to identify riskfactors for long-term allograft function, outcome and survival. The calibration and prognostic accuracyof the risk models were evaluated using the Hosmer–Lemshow test (HLT) and the area underthe receiver operating characteristic curve (AUC) model. Results: In total, 94 of 204 (47%) patients received(sub)therapeutic antithrombotic therapy after transplantation and 108 (53%) patients receivedprophylactic antithrombotic therapy. A total of 61 (29%) patients showed signs of postoperativebleeding. The incidence (p < 0.01) and timepoint of bleeding (p < 0.01) varied significantly betweenthe different antithrombotic treatment groups. After applying multivariate analyses, pre-existingcardiovascular disease (CVD) (OR 2.89 (95% CI: 1.02–8.21); p = 0.04), procedure-specific complications(blood loss (OR 1.03 (95% CI: 1.0–1.05); p = 0.014), Clavien–Dindo classification > grade II (OR 1.03(95% CI: 1.0–1.05); p = 0.018)), HAS-BLED score (OR 1.49 (95% CI: 1.08–2.07); p = 0.018), vit K antagonists(VKA) (OR 5.89 (95% CI: 1.10–31.28); p = 0.037), the combination of APT and therapeuticheparin (OR 5.44 (95% CI: 1.33–22.31); p = 0.018) as well as postoperative therapeutic heparin (OR 3.37(95% CI: 1.37–8.26); p < 0.01) were independently associated with an increased risk for bleeding. Theintraoperative use of heparin, prior antiplatelet therapy and APT in combination with prophylactic heparin was not associated with increased bleeding risk. Higher recipient body mass index (BMI)(OR 0.32 per 10 kg/m2 increase in BMI (95% CI: 0.12–0.91); p = 0.023) as well as living donor KT(OR 0.43 (95% CI: 0.18–0.94); p = 0.036) were associated with a decreased risk for bleeding. Regardingbleeding events and graft failure, the HAS-BLED risk model demonstrated good calibration (bleedingand graft failure: HLT: chi-square: 4.572, p = 0.802, versus chi-square: 6.52, p = 0.18, respectively) andmoderate predictive performance (bleeding AUC: 0.72 (0.63–0.79); graft failure: AUC: 0.7 (0.6–0.78)).Conclusions: In our current study, we could demonstrate the HAS-BLED risk score as a helpful toolwith acceptable predictive accuracy regarding bleeding events and graft failure following KT. Theintensified monitoring and precise stratification/assessment of bleeding risk factors may be helpfulin identifying patients at higher risks of bleeding, improved individualized anticoagulation decisionsand choices of antithrombotic therapy in order to optimize outcome after kidney transplantation

Zugangsstatus: Freier Zugang

Rechte-/Nutzungshinweise: Namensnennung (CC BY)

Nur in Feld suchen:

Zuletzt gesuchte Begriffe: