PB1010 - Activated Partial Thromboplastin Time and Factor XI are associated with risk of bleeding in patients on hemodialysis

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Oliver Königsbrügge, MD PhD

Physician
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Co-Author(s)

RK

Renate Klauser-Braun

Department head
Clinic Favoriten
Vienna, Wien, Austria
RK

Renate Klauser-Braun

Department head
Clinic Donaustadt
Vienna, Wien, Austria
ML

Matthias Lorenz

Professor
Vienna Dialysis Center
Vienna, Wien, Austria
PQ

Peter Quehenberger

Professor
Department of Laboratory Medicine, Medical University of Vienna
Vienna, Wien, Austria
Ingrid Pabinger

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
MS

Marcus Säemann

Department head
Clinic Ottakring
Vienna, Wien, Austria
Cihan Ay, MD

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Background: Patients with end-stage kidney disease on hemodialysis (HD) are at increased risk of bleeding and thromboembolic complications, but biomarkers for these events are unconfirmed in HD patients.

Aims: We aimed to investigate the association of coagulation parameters with thromboembolic and bleeding outcomes in HD patients.

Methods: From a cohort of HD patients (N=451), we sampled blood at study inclusion after informed consent. Patients were prospectively observed for a maximum of 45 months and outcome events, (1) a composite arterial thromboembolic outcome of ischemic stroke, transient ischemic attack and systemic embolism and (2) major bleeding, were recorded and independently adjudicated. Patients on vitamin-K-antagonists were excluded and heparin was ruled out by anti-Xa assay. A panel of coagulation parameters was measured and analyzed for association with the outcome events in competing risk regression.

Results: Thromboembolic events occurred in 32 (7.1%) patients, and 62 (13.7%) patients had major bleeding. vWF levels were associated with an increased risk of the thromboembolic outcome in univariable analysis (table 1), but the association between vWF and stroke was attenuated (hazard ratio [HR] per 10 units increase 1.024, 95%CI 0.984-1.066, p=0.242) in multivariable analysis adjusted for age, atrial fibrillation, and prior stroke.
Prolongation of the APTT was associated with increased risk of bleeding (HR 1.020, 95%CI 1.001-1.039, p=0.043) and higher FXI levels were associated with reduced risk of bleeding (HR 0.884, 95%CI 0.797-0.980, p=0.019) in univariable analysis. In multivariable analysis adjusted for history of major bleeding and antiplatelet therapy both APTT and FXI level remained significantly associated with bleeding risk (HR 1.022, 95%CI 1.000-1.043, p=0.046 and HR 0.989, 95%CI 0.978-0.999, p=0.038).

Conclusion(s): Amongst the investigated coagulation parameters, there were none associated with an increased risk of thromboembolic outcomes. A prolongation of the APTT was however associated with an increased risk of bleeding, while increasing FXI activity appeared to prevent major bleeding events.