LOW-DOSE ASPIRIN DOES NOT PREVENT THROMBOVASCULAR ACCIDENTS IN LOW-RISK HEMODIALYSIS-PATIENTS DURING TREATMENT WITH RECOMBINANT-HUMAN-ERYTHROPOIETIN

Treatment of the anaemia of renal disease with recombinant human eryth ropoietin results in an improvement of haemostasis and an increased ri sk of thrombovascular accidents. In this prospective, placebo-controll ed, double-blind, and cross-over study, the effects of low-dose acetyl salicylic acid (30 mg daily) on thrombotic and bleeding events during the initial period of treatment with erythropoietin in anaemic haemodi alysis patients without previous thrombovascular accidents or known in creased risk for thrombosis were investigated. During correction of th e haematocrit and the first 3 months thereafter, group A (n = 68) rece ived placebo and group B (n = 69) 30 mg acetylsalicylic acid daily. CT OSS-over took place after the 3rd month of a stable haematocrit. The s tudy ended 3 months later. Target haematocrit (30-35%) was reached in 12.4 +/- 8 weeks (M +/- SD). In group A the bleeding time was 382 +/- 285 s, decreasing to 282 +/- 208 before cross-over (P < 0.01), and inc reasing to 395 +/- 271 (P < 0.05) thereafter. In group B the bleeding time was 390 +/- 381 s, 406 +/- 267 (NS), and 285 +/- 238 (P < 0.05) r espectively. Twenty-two thrombovascular accidents were seen (16%, 13 d uring acetylsalicylic acid and 9 during placebo, NS), including 17 fis tula thromboses. The incidence of bleeding events was not significantl y different between regimens. In conclusion, erythropoietin treatment resulted in a reduction of the bleeding time. When 30 mg acetylsalicyl ic acid was taken during the treatment, the bleeding time did not decr ease. The regimen did not result in an increased number of bleeding ev ents, but neither were thrombovascular accidents prevented in low-risk patients.