Low-dose aspirin does not prevent thrombovascular accidents in low-risk haemodialysis patients during treatment with recombinant human erythropoietin

Treatment of the anaemia of renal disease with recombinant humanerythropoietin results in an improvement of haemostasis andan increased risk of thrombovascular accidents. In this prospective,placebo-controlled, double-blind, and cross-over study, theeffects of low-dose acetylsalicylic acid (30 mg daily) on thromboticand bleeding events during the initial period of treatment witherythropoietin in anaemic haemodialysis patients without previousthrombovascular accidents or known increased risk for thrombosiswere investigated. During correction of the haematocrit andthe first 3 months thereafter, group A (n = 68) received placeboand group B (n = 69) 30 mg acetylsalicylic acid daily. Cross-overtook place after the 3rd month of a stable haematocrit. Thestudy 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±285s, decreasing to 282±208 before cross-over (P<0.0l),and increasing to 395±271 (P<0.05) there after. Ingroup B the bleeding time was 390±381 s, 406±267(NS), and 285±238 (P<0.05) respectively. Twenty-twothrombovascular accidents were seen (16%, 13 during acetylsalicylicacid and 9 during placebo, NS), including 17 fistula thromboses.The incidence of bleeding events was not significantly differentbetween regimens. In conclusion, erythropoietin treatment resulted in a reductionof the bleeding time. When 30 mg acetylsalicylic acid was takenduring the treatment, the bleeding time did not decrease. Theregimen did not result in an increased number of bleeding events,but neither were thrombovascular accidents prevented in low-riskpatients.