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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Anticoagulation management in ICU patients with chronic kidney disease (CKD) presents competing risks of bleeding and thrombosis, with limited evidence comparing different strategies. We aimed to compare the incidence of acute kidney injury (AKI) and mortality across anticoagulation approaches in critically ill CKD patients.
We conducted a retrospective cohort study using the MIMIC-IV database, including adult ICU patients with pre-existing CKD (stages 2-5, eGFR <90 mL/min/1.73m²) receiving anticoagulation between 2008-2022. Patients were classified by primary anticoagulant: warfarin, direct oral anticoagulants (DOACs), or heparin/low-molecular-weight heparin. The primary outcome was AKI by KDIGO criteria. Secondary outcomes included major bleeding, in-hospital mortality, and composite endpoints. We performed multivariable logistic regression and propensity score analysis with inverse probability weighting.
Among 2,671 patients, 704 (26.4%) received warfarin, 340 (12.7%) DOACs, and 1,627 (60.9%) heparin. Despite the highest AKI incidence (70.0% vs 60.6% DOACs and 62.8% heparin, p<0.001; adjusted OR 1.250, 95% CI: 1.021-1.530, p=0.031), warfarin unexpectedly demonstrated the lowest in-hospital mortality (8.8% vs 11.8% DOACs and 21.9% heparin, p<0.001; adjusted OR 0.345, 95% CI: 0.259-0.459, p<0.001). Major bleeding was highest with DOACs (39.1%) compared to warfarin (25.7%) and heparin (23.0%, p<0.001). AKI recovery rates were similar across groups (warfarin 64.5%, DOACs 63.6%, heparin 65.5%, p=0.843). Among warfarin users, optimal INR control (2.5-3.0) was associated with the lowest AKI incidence (55.4%), while subtherapeutic INR (<2.0) corresponded to the highest rate (73.9%).
Figure 1. Kaplan-Meier curves showing AKI-free survival by anticoagulation strategy in ICU patients with CKD. Curves represent warfarin, direct oral anticoagulants (DOACs), and heparin/low-molecular-weight heparin groups. Numbers at risk are displayed below the curves. Log-rank test p<0.001.
In ICU patients with CKD, warfarin was associated with higher AKI incidence but paradoxically lower mortality compared to alternative anticoagulants. This unexpected finding may reflect reversible kidney injury with enhanced monitoring benefits and warrants confirmation in randomised trials before changing clinical practice.
