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Clinical outcome of patients with venous thromboembolism and renal insufficiency - Findings from the RIETE registry

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: https://doi.org/10.1160/TH07-02-0132
Issue: 2007: 98/4 (Oct) pp. 705-915
Pages: 771-776

Clinical outcome of patients with venous thromboembolism and renal insufficiency - Findings from the RIETE registry

Conxita Falgá 1, Josep Antón Capdevila 2, Silvia Soler 3, Ramón Rabuñal 4, Juan Francisco Sánchez Muñoz-Torrero 5, Pedro Gallego 6, Manuel Monreal 7, and the RIETE Investigators*
1 Servicio de Medicina Interna, Consorci Sanitari del Maresme, Mataró, Spain; Facultat de Medicina, Universitat Autónoma de Barcelona, Spain; 2Servicio de Medicina Interna, Consorci Sanitari del Maresme, Mataró, Spain; 3 Servicio de Medicina Interna, Hospital Sant Jaume, Olot, Spain; 4Servicio de Medicina Interna, Complexo Hospitalario Xeral- Calde, Lugo, Spain; 5 Servicio de Medicina Interna, Hospital San Pedro de Alcántara, Cáceres, Spain; 6 Servicio de Medicina Interna, Hospital SAS de Jerez, Cádiz, Spain; 7 Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Facultat de Medicina, Universitat Autónoma de Barcelona, Spain

Keywords

venous thromboembolism, Renal insufficiency, anticoagulant therapy

Summary

There is little information on the clinical outcome of patients with venous thromboembolism and renal insufficiency. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE). In this analysis we analyzed the three-month outcome in patients with creatinine clearance (CrCl) <30 ml/min. As of March 2007, 1,037 of the 18,251 (5.7%) patients enrolled in RIETE had CrCl <30 ml/min. During the three-month study period these patients had an increased incidence of fatal bleeding, fatal PE, and overall death compared to those with CrCl >30 ml/min. Of the 579 patients presenting with clinically overt PE, 52 (9.0%) died of the initial PE, 13 (2.2%) of recurrent PE, and nine (1.6%) died of bleeding complications. During the first 15 days of therapy the 10% incidence of fatal PE was 10-fold their 1.0% of fatal bleeding. From day 16 to 90, the 1.0% rate of fatal PE was not significantly higher than the 0.5% of fatal bleeding. Of the 458 DVT patients with CrCl <30 ml/min, 14 (3.1%) had fatal bleeding and only one (0.2%) died of PE. In patients with CrCl <30 ml/min presenting with clinically overt PE the main threat is PE itself. On the contrary, in those with DVT the main threat is bleeding.

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