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Comparison of Standard and Global Coagulation Tests in Hemodialysis Patients
Smita Divyaveer1, Sarah Chahal2, Madhuri Kashyap1
1Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Insights
Global coagulation tests (GCT) better reflect coagulation status in dialysis patients than standard coagulation tests (SCT). GCT parameters, unlike SCT, significantly correlate with thrombotic events in chronic kidney disease patients.
Area of Science:
- Nephrology
- Hematology
- Clinical Chemistry
Background:
- Chronic kidney disease (CKD) is linked to bleeding and thrombosis risks.
- Standard coagulation tests (SCT) have limitations in assessing coagulation status.
- Global coagulation tests (GCT) offer real-time, detailed coagulation analysis.
Purpose of the Study:
- To compare SCT and GCT in dialysis patients.
- To analyze correlations between coagulation tests and clinical hemostatic events.
Main Methods:
- Prospective observational cross-sectional study.
- 50 adult CKD stage 5D (dialysis) patients.
- Collected clinical data and blood samples for SCT and GCT pre-dialysis.
Main Results:
- Bleeding (7 patients) and thrombosis (5 patients) observed.
- Some SCT and GCT parameters correlated, but SCT generally didn't predict events.
- GCT parameters (clot rate, time to peak, platelet function) significantly associated with thrombotic episodes.
Conclusions:
- SCT and GCT parameters showed poor correlation.
- SCT did not reliably predict bleeding or thrombotic events.
- GCT parameters are superior to SCT for assessing coagulation in dialysis patients.
Background:
Chronic kidney disease (CKD) is associated with an increased tendency of bleeding and thrombosis. There are multiple factors that interact with each other to cause either in CKD patients. Conventional or standard coagulation tests (SCT) have several limitations. Global coagulation test (GCT), such as Sonoclot, gives a real-time detailed analysis of coagulation status.
Materials And Methods:
This is a prospective observational cross-sectional study of 50 adult CKD stage 5D (dialysis) patients conducted from January 2020 to January 2022. Clinical details were noted and blood samples were taken for conventional and global coagulation tests prior to dialysis. Correlation between SCT and GCT as well as clinical hemostatic events was analyzed.
Results:
Fifty patients were enrolled. Bleeding and thrombosis occurred in 7 and 5 patients, respectively. There was a significant correlation between some SCT and GCT parameters. None of the SCT parameter derangement was associated with any thrombotic episodes except increased fibrinogen level which was associated with thrombotic events. On the contrary, patients with hypocoagulability according to SCT actually had thrombotic events. Parameters of GCT, such as clot rate, time to peak, and platelet function were significantly associated with thrombotic episodes.
Conclusion:
SCT and GCT parameters do not correlate with each other. SCT is not associated with clinically significant bleeding and thrombotic events. Some GCT parameters are associated with thrombotic events. GCT are real time and are better than SCT to reflect the coagulation status in patients on dialysis.
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