Coagulation activation, depletion of platelet granules and endothelial integrity in case of uraemia and haemodialysis treatment

Schoorl, Marianne; Schoorl, Margreet; Nubé, Menso J.; Bartels, P. C. M.

doi:10.1186/1471-2369-14-72

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…Platelets also had been significantly reduced by TPE. Unfortunately, we do not know by simple platelet count analysis if the contact with the TPE equipment affects their function which has been shown previously nor if there are differences in regards to platelet function when comparing TPE with albumin to TPE with fresh frozen plasma [ 31 , 32 ]. As if matters are not already complicated enough, anticoagulatory factors are also depleted by TPE.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

et al. 2015

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BackgroundTherapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM).MethodologyTen patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE.Principal FindingsTPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness.Conclusions/SignificanceTPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies.

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Section: Discussionmentioning

confidence: 99%

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

et al. 2015

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“…deceased donor KTx-is an evolving issue: international consensus and guidelines suggest to evaluate bleeding and thrombotic risk for decision making, but no specific recommendation is made for kidney transplant surgery [12]. Actually, kidney transplant recipients (KTR) represent a very peculiar population in which baseline thrombotic and hemorrhagic risk are both elevated if compared with the general population [10], as end-stage renal disease (ESRD) is associated with complex and severe vascular alterations [13,14] and sub-clinical inflammation [15] and, on the other side, platelet aggregation defects [16,17]. Therefore, results inferred from different populations might not directly apply to KTx surgery or recipients.…”

Section: Introductionmentioning

confidence: 99%

Impact of pre-transplant antiaggregant and anticoagulant therapies on early hemorrhagic and cardiovascular events after kidney transplantation

et al. 2015

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“…A high mortality rate ratio [18] resulting from myocardial infarction within the 3 years of hemodialysis and a high AMI incidence [20] in hemodialysis patients have been reported in previous studies. The higher risk of AMI in hemodialysis patients has been attributed to the increased probability of blood clot formation as a result of coagulation activation, depletion of platelet granules, and endothelial integrity [21].…”

Section: Discussionmentioning

confidence: 99%

Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent

Kumar

Tsai

Tan

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Acute myocardial infarction (AMI) is one of the most important perioperative complications of total knee arthroplasty (TKA). Although risk-stratification tools exist for the prediction of cardiac complications including AMI after noncardiac surgery, such stratification does not differentiate the patients with a coronary stent alone, AMI without a stent, or AMI with a stent. The risk of postoperative AMI in these patient groups may vary. Several studies have recommended suitable times for noncardiac surgery in patients with a coronary stent; however, they do not differentiate between the patients with AMI and no AMI. The suitable time of noncardiac surgery for patients with AMI and stent may vary from those with a stent alone. Moreover, a study to evaluate the risk of AMI within 1 year in an Asian population with a history of AMI or coronary stent who underwent TKA has not been reported. Questions/purposes (1) What are the risks of AMI within 1 year of TKA in patients who have had a stent alone, AMI without a stent, or AMI with a stent as compared with patients without an AMI/stent? (2) For patients with AMI/ stent placement, when can TKA be performed where the risk of subsequent AMI normalizes? (3) What comorbidities are associated with post-TKA AMI? (4) Is the risk of AMI within 1 year after surgery in patients undergoing TKA without a history of AMI/stent higher than that in patients with no surgery? Methods This study is a retrospective study of the medical claim records of 128,216 patients who underwent TKA between 1997 and 2010 in Taiwan. The records were retrieved from the research database of the Bureau of National Health Insurance in Taiwan, which maintains the records of 99.68% of the Taiwan population. The patients who had a history of AMI or coronary stent placement within the year before TKA were compared with the patients who had not experienced AMI or stent placement before TKA. The control subjects were matched according to sex, age, Charlson score, and year of surgery. There were 2413 patients in each group. The patients with a history of AMI or stent placement and the timing of TKA after coronary event were further stratified as with a coronary stent alone, AMI without a stent, and AMI with a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Conclusions This study found the risk of post-TKA AMI remains high within 1 year in patients with a history of AMI/stent. It is recommended that an elective TKA should be performed at least 1 year after an episode of AMI or stent placement. Stents do not provide protection against post-TKA AMI within 6 months of the AMI and patients with AMI + stent have a higher risk of AMI than those with only AMI. Patients of AMI/stent on hemodialysis have a very high risk of post-TKA AMI. However, the risk of AM...

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Coagulation activation, depletion of platelet granules and endothelial integrity in case of uraemia and haemodialysis treatment

Cited by 18 publications

References 27 publications

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

Impact of pre-transplant antiaggregant and anticoagulant therapies on early hemorrhagic and cardiovascular events after kidney transplantation

Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent

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