Abstract: SA-PO713
Assessing Bleeding Risk in CKD Using Global Coagulation Assays
Session Information
- Pathology and Lab Medicine: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1602 Pathology and Lab Medicine: Clinical
Authors
- Langsford, David, Northern Health, Melbourne, Victoria, Australia
- Lui, Brandon, University of Melbourne, Melbourne, Victoria, Australia
- Pianta, Timothy J., Northern Health, Melbourne, Victoria, Australia
- Barit, David, Northern Health, Melbourne, Victoria, Australia
- Nandurkar, Harshal, Northern Health, Melbourne, Victoria, Australia
- Ho, Prahlad W., Northern Health, Melbourne, Victoria, Australia
- Lim, Yin H., Northern Health, Melbourne, Victoria, Australia
Background
Later stage CKD patients are often clinically hypocoaguable. Current coagulation studies do not sufficiently assess this risk. Global coagulation studies (GCA) are functional studies that can better describe bleeding and thrombosis risk. GCA includes whole blood thromboelastography (TEG), platelet-poor calibrated automated thrombogram (CAT), overall haemostatic potential (OHP). TEG is well established in the management of major haemorrhage and massive transfusion. We aim to evaluate using GCA in CKD patients to help define bleeding or thrombosis risks.
Methods
We prospectively recruited 2 groups of stable CKD patients. Pre-dialysis with eGFR<30 ml/min/1.73m2 (n=24) and dialysis patients (n=46 haemodialysis, n=10 peritoneal dialysis) were compared to healthy controls (n=138). Baseline renal, hematological investigations and GCA were compared using t-test and chi-square statistics.
Results
Compared to controls (67% female, mean age 42, creatinine 70umol/L) predialysis CKD (46% female, mean age 70, creatinine 237umol/L, urea 18.6mmol/L, eGFR 22 ml/min/1.7m2) had increased von Willebrand factor (VWF) antigen (223 vs 102%, p<0.001), factor VIII (208 vs 108%, p<0.001) and D-dimer (1188 vs 430, p<0.001). Pre-dialysis CKD were prothrombotic with increased maximum amplitude (MA, a measure of clot strength) of 68 vs 60mm (p<0.01) compared to controls. In predialysis CKD, there was no association between urea or eGFR and MA. Thrombin generation (peak thrombin 269 vs 219nM, p<0.01) and fibrin generation (OHP 41 vs 29, p<0.01) were increased with impaired fibrinolysis (OFP 42 vs 50%, p<0.01) compared with controls. Dialysis patients (38% female, mean age 66) also had increased clot strength (MA 70mm, p<0.01) and reduced fibrinolysis (OHP 41 U, OFP 40%, p<0.01) compared to controls. Measures of clot strength and overall fibrinolysis were not significantly different between pre-dialysis and dialysis patients.
Conclusion
Contrary to expectation, pre-dialysis CKD and dialysis patients were not found to be hypocoaguable using functional coagulation tests. Both groups were found to have markers conferring increased prothrombotic risk: elevated vWF, increased TEG measures and impaired fibrinolysis. The clinical significance of these results and the use of GCA to stratify both thrombotic and bleeding risk warrants further investigation.