Nierfunctie en ernstige bloedingen bij patiënten behandeld met cumarines

BACKGROUND: Although anticoagulation therapy is closely monitored in the Netherlands, coumarin-induced serious bleeding events are still observed. Current literature suggests that renal impairment may contribute to this. OBJECTIVE: To explore the association between renal function and bleeding events during coumarin treatment. DESIGN: A nested case-control study was conducted using data from the PHARMO Database Network. METHODS: Patients hospitalised for a bleeding event during coumarin treatment were selected as cases and matched on sex, birth year, and geographic region with a maximum of two controls using coumarins without hospitalisation for bleeding. All values of estimated glomerular filtration rates (eGFRs) in the year before index date (case hospitalisation date) were selected and compared between cases and controls using logistic regression analyses. RESULTS: In total, 2224 cases were matched to 4398 controls 161% male; mean age ± SD = 75 ± 11 and 78 ± 11 years for cases and controls, respectively). Availability of eGFR values was higher among cases compared with controls (mean eGFR values ± SD = 4.5 ± 7.1 versus 3.2 ± 5.5), reflected in the significantly shorter time since last eGFR value lat index date, mean ± SD = 2.7 ± 3.0 versus 3.8 ± 3.1 months; odds ratio [OR] = 0.91, 95%CI = 0.89-0.92). No statistically significant difference was found for the mean eGFR value in the year before index date (mean ± SD 65.7 ± 22.8 versus 64.6 ± 20.9 mL/min/1.73 m; OR per 10 units = 0.99, 95%CI = 0.96-1.02). CONCLUSION: No association between renal function and serious bleeding events during coumarin treatment was observed.