Aspirin Prescription and Outcomes in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
Received 1 February 2007; accepted 5 July 2007. published online 06 September 2007.
Background
We investigated aspirin-prescribing patterns and potential benefits on cardiovascular morbidity and mortality in hemodialysis patients.
Study Design
Cohort study.
Setting & Participants
Data included 28,320 randomly selected hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study I and II.
Predictor
Aspirin prescription at study baseline.
Outcomes & Measurements
Prescription was investigated by means of logistic regression. All-cause mortality, all-cause hospitalization, cardiac event, myocardial infarction, cerebrovascular (CVA), gastrointestinal bleed, transient ischemic attack, and subdural hematoma were examined. Cox regression examined the risk of mortality and hospitalization. All models accounted for facility clustering and demographics and comorbid conditions.
Results
Wide variation was found in aspirin prescription, from 8% in Japan to 41% in Australia and New Zealand. Characteristics significantly associated with increased odds of prescription included coronary artery disease, cerebrovascular disease, diabetes, male sex, nonblack race, peripheral vascular disease, age, hypertension, and absence of gastrointestinal bleeding. Aspirin was associated with decreased risk of stroke in all patients (relative risk [RR], 0.82; P < 0.01) and increased risk of myocardial infarction (RR, 1.21; P = 0.01) and cardiac event (RR, 1.08; P < 0.01) in all patients, with similar results for patients with coronary artery disease. There was no increase in gastrointestinal bleeding.
Limitations
Observational studies are not protected from biases, despite adjustments. There is potential for aspirin use to be underreported because of its availability without prescription.
Conclusions
The hypothesis that prescribing aspirin to hemodialysis patients decreases cardiovascular disease risk is not supported. Aspirin might decrease CVA and appears not to increase hemorrhagic risk. This should be an incentive for randomized controlled trials.
8Department of Biostatistics, University of Michigan, Ann Arbor, MI
9Veterans Affairs Medical Center/University of Michigan, Ann Arbor, MI.
Address correspondence to Jean Éthier, MD, Centre Hospitalier de l’Université de Montréal, Hôtel Dieu de Montréal, 3840, rue Saint-Urbain, Montreal, Québec H2W 1T8 Canada.
ABSTRACT