Aspirin Prescription and Outcomes in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Éthier, Jean; Bragg-Gresham, Jennifer L.; Piera, Luis; Akizawa, Tadao; Asano, Yasushi; Mason, Nancy; Gillespie, Brenda W.; Young, Eric W.

doi:10.1053/j.ajkd.2007.07.007

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 4 , Pages 602-611, October 2007

Aspirin Prescription and Outcomes in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Jean Éthier, MD
- Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- 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.
Jennifer L. Bragg-Gresham, MS
- Arbor Research Collaborative for Health, Ann Arbor, MI
Luis Piera, MD
- Hospital General Vall D’Hebron, Barcelona, Spain
Tadao Akizawa, MD
- Department of Nephrology, Showa University School of Medicine, Tokyo, Japan
Yasushi Asano, MD, PhD
- Koga Red Cross Hospital, Ibaraki, Japan
Nancy Mason, PharmD
- University of Michigan, School of Pharmacology, Ann Arbor, MI
- Nephrology Pharmacy Associates, Ann Arbor, MI
Brenda W. Gillespie, PhD
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
Eric W. Young, MD, MS
- Veterans Affairs Medical Center/University of Michigan, Ann Arbor, MI.

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.

Index Words: Antiplatelet therapy, aspirin prescribing patterns, cardiovascular morbidity and mortality, hemodialysis patients