Saint-Georges Hospital Ajaltoun, Lebanon
Title: Cerebral hemorrhage in haemodialysis patients
Mabel Aoun has graduated in 2004 as a Nephrologist from the Université Saint-Joseph in Beirut-Lebanon. She completed her fellowship in nephrology at Kremlin- Bicêtre Hospital in Paris-France. She has a diploma in Renal Pathology from Université Saint-Antoine, Paris. She is the head of department of Nephrology and Dialysis at Saint-Georges Hospital Ajaltoun-Lebanon. She was responsible for the training of interns and residents from Saint-Joseph University and Kaslik University between 2007-2012. She is also a consultant in nephrology at the lebanese ministry of public health since 2012. Her main interests are glomerulonephritis’ pathology and treatment as well as the improvement of haemodialysis and peritoneal dialysis treatments in her country.
Antiplatelets therapy and anticoagulants are widely used in hemodialysis (HD) patients as a primary or secondary prevention for cardiovascular diseases. Their major side effect in this population is cerebral or digestive hemorrhage. We conducted a retrospective study in our center between 2005 and 2011 to find out whether the prescription of these drugs is well indicated and when it should be avoided in hemodialysis patients. 125 patients were dialyzed in our center between January 2005 and December 2011. They were divided into two groups. Group I included 68 patients who were not taking any antiplatelet or anticoagulant treatment. Group II included 57 patients: 26 were taking aspirin, 16 clopidogrel and 15 acenocoumarol. The mortality in Group I was 50% without any hemorrhagic complications. In Group 2 the mortality was 74 %. 19% in group 2 experienced hemorrhagic complications (6 cerebral and 5 digestive). 9 out of 42 deaths (21%) in Group 2 were secondary to hemorrhagic events: five patients on antiplatelet therapy developed hemorrhagic stroke and four patients on oral anticoagulant died because of digestive bleeding. The five patients who were on aspirin and died of cerebral hemorrhage were all uncontrolled hypertensive patients. Our results suggest that antiplatelet therapy represent a high risk for cerebral hemorrhage in patients with end-stage renal disease on chronic hemodialysis especially in those with uncontrolled hypertension. In summary we conclude that prophylactic aspirin should be used with caution in hypertensive patients on HD.