Cieri Isabella Ferlini, Patel Shiv, Rodriguez Alvarez Adriana A, Boya Mounika, Nurko Andrea, Teeple William, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Ann Vasc Surg. 2025 Apr;113:267-277. doi: 10.1016/j.avsg.2025.01.026. Epub 2025 Jan 28.
Chronic Kidney Disease (CKD) has been associated with a prothrombotic state. CKD affects hemostasis through altered platelet function and coagulation factors. Traditional tests provide limited insight into these changes. We used Thromboelastography (TEG) to evaluate coagulation profiles in CKD and non-CKD patients, comparing parameters based on glomerular filtration rate (GFR) to better understand clotting dynamics. The aim of the study was to evaluate coagulation profiles in patients across GFR categories using Thromboelastography (TEG), which enables comprehensive assessment of clot formation dynamics.
We prospectively evaluated patients with peripheral artery disease undergoing revascularization (December 2020-2023). Patients were stratified by GFR into 3 groups: >60 mL/min, 30-59 mL/min, and <30 mL/min. Pre-surgical blood samples were analyzed using TEG parameters, including Maximum Amplitude (MA), Citrated Functional Fibrinogen (CFF), and Functional Fibrinogen Levels (FLEV). Statistical analysis employed Kruskal-Wallis tests.
Among 254 patients (182 with GFR >60, 56 with GFR 30-59, and 16 with GFR <30), those with declining kidney function showed progressively higher values in CRT MA (62.80 vs. 65.85 vs. 67.85 mm, P = 0.0021), CK MA (61.10 vs. 64.00 vs. 66.70 mm, P = 0.0063), CFF MA (21.40 vs. 24.10 vs. 33.70 mm, P = 0.0017), and CFF FLEV (390.5 vs. 487.2 vs. 556.6 mg/dL, P = 0.0029). This pattern persisted in patients on mono antiplatelet therapy (MAPT). Patients receiving MAPT showed consistently higher coagulation marker levels compared to those on dual antiplatelet therapy (DAPT), particularly in severe renal impairment (GFR <30).
Patients with decreased kidney function demonstrated relative hypercoagulability compared to those with normal kidney function, as evidenced by elevated fibrinogen levels and stronger blood clots. While DAPT was associated with lower coagulation marker levels compared to MAPT, platelet reactivity remained similar across GFR categories. However, these laboratory findings did not translate into increased clinical events, with no significant differences in bleeding episodes (P = 0.436) or arterial thrombotic events (P = 0.095) across GFR categories.
慢性肾脏病（CKD）与血栓前状态有关。CKD通过改变血小板功能和凝血因子来影响止血。传统检测方法对这些变化的了解有限。我们使用血栓弹力图（TEG）来评估CKD和非CKD患者的凝血情况，根据肾小球滤过率（GFR）比较各项参数，以更好地了解凝血动态。本研究的目的是使用血栓弹力图（TEG）评估不同GFR类别的患者的凝血情况，TEG能够全面评估凝血形成动态。
我们前瞻性地评估了接受血管重建术的外周动脉疾病患者（2020年12月至2023年）。患者根据GFR分为3组：>60 mL/min、30 - 59 mL/min和<30 mL/min。术前血样采用TEG参数进行分析，包括最大振幅（MA）、枸橼酸化功能性纤维蛋白原（CFF）和功能性纤维蛋白原水平（FLEV）。统计分析采用Kruskal-Wallis检验。
在254例患者中（182例GFR>60，56例GFR 30 - 59，16例GFR<30），肾功能下降的患者在CRT MA（62.80 vs. 65.85 vs. 67.85 mm，P = 0.0021）、CK MA（61.10 vs. 64.00 vs. 66.70 mm，P = 0.0063）、CFF MA（21.40 vs. 24.10 vs. 33.70 mm，P = 0.0017）和CFF FLEV（390.5 vs. 487.2 vs. 556.6 mg/dL，P = 0.0029）方面呈现出逐渐升高的值。这种模式在接受单药抗血小板治疗（MAPT）的患者中持续存在。与接受双联抗血小板治疗（DAPT）的患者相比，接受MAPT的患者凝血标志物水平始终较高，尤其是在严重肾功能损害（GFR<30）的患者中。
与肾功能正常的患者相比，肾功能下降的患者表现出相对高凝状态，纤维蛋白原水平升高和血凝块更强证明了这一点。虽然与MAPT相比，DAPT与较低的凝血标志物水平相关，但血小板反应性在不同GFR类别中保持相似。然而，这些实验室结果并未转化为临床事件增加，不同GFR类别在出血事件（P = 0.436）或动脉血栓事件（P = 0.095）方面无显著差异。
