Thrombotic Risk and Platelet Effects Associated with Darbepoetin

Introduction to Thrombotic Risk

• The National Kidney Foundation recommends monitoring for thrombotic complications rather than thrombocytopenia when using ESAs in patients with CKD and diabetes 1, 2

Thrombotic Risk and ESA Use

• A large clinical trial in CKD patients showed a 92% increase in relative risk of stroke with darbepoetin alfa when targeting hemoglobin of 13 g/dL, according to the Kidney International guidelines 1
• Meta-analyses report increased relative risk of thrombotic events ranging from 48% to 69% with ESA use, with absolute venous thromboembolism risk of 7.5% versus 4.9% in controls, as stated by the Journal of the National Comprehensive Cancer Network 2

Iron Supplementation and ESA Therapy

• The American Journal of Kidney Diseases suggests ensuring adequate iron supplementation during ESA therapy, as the majority of CKD patients require supplemental iron 4
• Iron deficiency from blood losses may coexist with anemia management, according to the Praxis Medical Insights guidelines 3

Medication Review and Thrombocytopenia

• Review all medications for known associations with thrombocytopenia, as recommended by the Journal of the National Comprehensive Cancer Network 2
• ACE inhibitors have been reported to potentially interfere with ESA response but not cause thrombocytopenia, according to the American Journal of Kidney Diseases 4

Platelet Count Variation and ESA Use

• Mild thrombocytopenia may represent chronic disease state rather than drug effect, as stated by the Journal of the National Comprehensive Cancer Network 2
• Monitor for signs of bleeding or thrombosis rather than focusing on mild platelet count variation, according to the Journal of the National Comprehensive Cancer Network 2