Haemostatic profiles assessed by thromboelastography in patients with end-stage renal disease

Andrew Darlington; Josè Luis Ferreiro; Masafumi Ueno; Yoshi Suzuki; Bhaloo Desai; Piera Capranzano; Davide Capodanno; Antonio Tello-Montoliu; Theodore A. Bass; S Nahman Norris; Dominick J. Angiolillo

doi:10.1160/TH10-12-0785

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(01): 67-74
DOI: 10.1160/TH10-12-0785

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Haemostatic profiles assessed by thromboelastography in patients with end-stage renal disease

Authors

Andrew Darlington

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Josè Luis Ferreiro

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Masafumi Ueno

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Yoshi Suzuki

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Bhaloo Desai

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Piera Capranzano

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Davide Capodanno

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Antonio Tello-Montoliu

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Theodore A. Bass

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
S Nahman Norris

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
Dominick J. Angiolillo

¹University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA

Abstract

Summary

Patients with end-stage renal disease (ESRD) have abnormalities in the cellular and plasmatic systems regulating blood homeostasis, which may contribute to their risk for thrombotic and bleeding complications. However, their relative contributions in this population are poorly understood. The aim of this study was to evaluate the distribution of enzymatic and cellular abnormalities in ESRD patients on haemodialysis as assessed by thromboelastography (TEG^®). Whole blood samples were analysed by TEG in ESRD patients (n=70) and in a control group (n=70) of subjects with coronary artery disease. Profiles were constructed considering the maximum amplitude (MA), a marker of platelet function, and reaction time (R), a marker of thrombin generation, values. R values were higher in ESRD patients compared with the control group (8.2 ± 2.8 vs. 5.7 ± 1.9 minutes [min], p <0.0001), while there were no differences in MA (66.7 ± 8.1 vs. 66.2 ± 6.6 mm, p=0.562). Nor mal manufacturer defined coagulation (2–8 min) and aggregation (51–69 mm) parameters were present in 31% of ESRD patients compared with 56% of controls (p=0.006). A hypocoagulable status was observed in 42.9% of ESRD patients compared with 8.9% in the control group (p<0.0001). There were no differences in platelet function, which showed a hyperaggregable status in 41.4% versus 35.7% of cases (p=0.603). Abnormalities in both parameters were observed in 15.7% of ESRD patients versus 1.4% in the control group (p = 0.004), which were more common among older patients (p= 0.005). In conclusion, patients with ESRD have an elevated prevalence of abnormal haemostatic profiles, which may contribute to their elevated risk of bleeding and thrombotic complications.

keywords

End stage renal disease - platelet function - coagulation

Full Text

References

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