Plasma haemostatic potential of haemodialysis patients assessed by thrombin generation assay: Hypercoagulability in patients with vascular access thrombosis

Abstract

Patients with end-stage renal disease (ESRD) on maintenance haemodialysis are predisposed to bleeding and thrombotic events. Recently thrombin generation assay (TGA) has been introduced as a laboratory assessment of global haemostatic potential. We investigated the global haemostatic potential assessed by TGA in ESRD patients on haemodialysis and patients who developed vascular access thrombosis. A total of 69 ESRD patients who underwent haemodialysis (58 stable patients and 11 vascular access thrombosis patients) were included and 33 healthy controls were included. TGA was performed on the calibrated automated thrombogram using tissue factor with/without addition of thrombomodulin or activated protein C, producing three parameters including lag time, endogenous thrombin potential (ETP) and peak thrombin. Haemodialysis patients showed low ETP values measured by thrombin generation assay compared with the healthy controls. Interestingly, patients with vascular access thrombosis exhibited short PT and aPTT and increased resistance of coagulation inhibition to APC anticoagulant protein, reflecting hyper-coagulability. Haemodialysis patients who are taking anti-platelet agents showed decreased thrombin inhibition rate, representing antithrombotic effect of anti-platelet agents. Whereas the haemodialysis patients showed hypo-coagulability, the patients with vascular access thrombosis exhibited hyper-coagulability. Further study is required to investigate how this haemostatic potential may be utilized to guide the physician to more effective management of haemostatic complication.