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. What is the context: ESRD patients on HD have a paradoxically increased risk of both thromboembolism and bleeding.International guidelines highlight the need for tools that can help clinicians to avoid these complications.T-TAS is an easy-to-use global hemostasis assay which hypothetically can be used to assess the risk of bleeding and thromboembolism in this patient group ESRD patients on HD have a paradoxically increased risk of both thromboembolism and bleeding. International guidelines highlight the need for tools that can help clinicians to avoid these complications. T-TAS is an easy-to-use global hemostasis assay which hypothetically can be used to assess the risk of bleeding and thromboembolism in this patient group What is new: Bleeding and thromboembolic complications are similarly common in ESRDT-TAS shows promising performance in detecting patients free from bleeding and thromboembolic complications during a one-year follow-up Bleeding and thromboembolic complications are similarly common in ESRD T-TAS shows promising performance in detecting patients free from bleeding and thromboembolic complications during a one-year follow-up What is the impact: T-TAS could be used to assess the risk of both bleeding and thromboembolic complications in HD patients.By identifying patients at higher risk of bleeding or thrombosis, healthcare providers could adjust antithrombotic therapies to reduce complications.Positive results in future properly designed studies may lead to the integration of this tool in HD patient care. T-TAS could be used to assess the risk of both bleeding and thromboembolic complications in HD patients. By identifying patients at higher risk of bleeding or thrombosis, healthcare providers could adjust antithrombotic therapies to reduce complications. Positive results in future properly designed studies may lead to the integration of this tool in HD patient care.