{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:28Z","timestamp":1786480288138,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/100015317","name":"University of Arkansas for Medical Sciences Translational Research Institute","doi-asserted-by":"crossref","award":["UL1 TR003107"],"award-info":[{"award-number":["UL1 TR003107"]}],"id":[{"id":"10.13039\/100015317","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["16SDG31000045"],"award-info":[{"award-number":["16SDG31000045"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001463","name":"American Society of Nephrology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001463","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2022,8,25]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Individuals aged \u226575 years are the fastest-growing population starting dialysis for end-stage kidney disease (ESKD) due to living longer with coronary artery disease. ESKD alone can increase bleeding risk, but P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor (P2Y12-I) antiplatelet medications prescribed for cardiovascular treatment can exacerbate this risk in patients with ESKD. The age-specific rates of bleeding complications in dialysis patients with ESKD on P2Y12-I remain unclear, as does how age modifies the bleeding risk from P2Y12-I use in these patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a retrospective cohort study, we collected data on 40,972 patients receiving maintenance hemo- or peritoneal dialysis who were newly prescribed P2Y12-I therapy between 2011 and 2015 from the USRDS registry. We analyzed the effect of age on the time to first bleed and the interactions between age and P2Y12-I type on modifying the effects of a bleed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty percent of the cohort were aged \u226575 years. There were 3096 (8%) gastrointestinal (GI) and 1298 (3%) intracranial (IC) bleeding events during a median follow-up of 1 year. Annual incidence rates for IC bleeds were 2% in those aged &lt;55 years and 3% in those aged \u226575 years. Rates for GI bleeds were 4% in those aged &lt;55 years and 9% in those aged \u226575 years. On clopidogrel, prasugrel, and ticagrelor, for every decade increase in age of the cohort members, the risk of IC bleed increased by 9%, 55%, and 59%, and the risk of GI bleed increased by 21%, 28%, and 39%, respectively. At age \u226575 years, prasugrel was associated with a greater risk of IC bleed than clopidogrel. At age \u226560 years, ticagrelor was associated with a greater risk of GI bleed than clopidogrel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More potent P2Y12-Is (prasugrel and ticagrelor) were associated with a disproportionately higher risk of IC bleed with increasing age compared with that of clopidogrel\u2014prasugrel was much worse than clopidogrel at age \u226575 years. All three drugs were associated with only modest increase in the risk of GI bleed with every decade increase in age\u2014ticagrelor was much worse than clopidogrel at \u226560 years of age. These results highlight the need for head-to-head clinical trials for the use of P2Y12-Is in patients with ESKD to determine age cutoffs where the risk of bleeding outweighs the benefits of thrombosis prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0002442022","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T13:55:16Z","timestamp":1652882116000},"page":"1374-1383","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Age Modifies Intracranial and Gastrointestinal Bleeding Risk from P2Y12 Inhibitors in Patients Receiving Dialysis"],"prefix":"10.34067","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-6579","authenticated-orcid":false,"given":"Nishank","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas"},{"name":"Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley C.","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junqiang","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6472-9325","authenticated-orcid":false,"given":"Milind A.","family":"Phadnis","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layth","family":"Al-Hindi","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-8783","authenticated-orcid":false,"given":"Theresa I.","family":"Shireman","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8850-4729","authenticated-orcid":false,"given":"S. Susan","family":"Hedayati","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafia S.","family":"Rasu","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, University of North Texas Health Sciences, Fort Worth, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-2097","authenticated-orcid":false,"given":"Jawahar L.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas"},{"name":"Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, 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