Prediction of bleeding and thromboembolic complications in patients on chronic hemodialysis with the total thrombus-formation analysis system.

Patients receiving hemodialysis (HD) are susceptible to bleeding and thrombosis. We assessed whether the T-TAS assay - which measures platelet thrombus formation (PL-AUC) and fibrin-rich thrombus formation (AR-OT) in whole blood under flow - could predict these complications in 176 chronic HD patients, monitoring bleeding and thromboembolic events over one year. During follow-up, 29 patients (16.5%) experienced at least one major or clinically relevant non-major bleeding (CRNMB) event, while 31 patients (17.6%) had at least one thromboembolic event. Patients with low thrombogenicity (PL-AUC below the median) had a more than fivefold increased risk of major bleed/CRNMB in multivariate analyses, and a C-statistic (ROC-AUC; 95% CI) for discrimination between future bleeding/no bleeding of 0.82 (0.74-0.90). AR-OT data showed comparable results. Further, the risk of thromboembolism was significantly lower in patients with PL-AUC below the median (multivariate OddsRisk [OR] ~0.20; C-statistic for thromboembolism/no thromboembolism of 0.73 [0.64-0.83]). Reduced fibrin-rich thrombus formation (AR-OT above median) was associated with ORs below 0.50 to develop thromboembolism in multivariate analyses (C-statistic 0.75 [0.65-0.85]). Excluding patients on oral antithrombotic agents (i.e. aspirin (n = 20) and warfarin (n = 14)), resulted in similar findings. In conclusion, T-TAS is a promising tool for assessing bleeding and thrombosis risk in HD patients.