P1251THROMBIN GENERATION ASSAY: A POTENTIAL TOOL TO STRATIFY THROMBOTIC RISK IN HEMODIALYSIS PATIENTS

Background and Aims Patients with Chronic Kidney Disease (CKD) in hemodialysis (HD) show both high thrombotic and hemorrhagic risks. However, routine laboratory techniques aimed to evaluate haemostasis, i.e. activated prothrombin time (PT) and activated partial thromboplastin time (aPTT), are not sensitive enough to detect mild hypocoagulable or hypercoagulable states in this population. Indeed, these methods evaluate the start-up phase of the coagulation, but omit the amplification stage in which an exponential increase of thrombin generation occurs. Thrombin generation assay (TGA) is a second-level global coagulative test able to evaluate thrombin generation and decay. So far the TGA has never been used for assessing thrombotic risk in HD patients. Method This is a monocentric observational retrospective study conducted at San Giovanni Bosco Hospital and University of Turin, Italy. After chart-reviewing of all patients with CKD in HD, we enrolled: Group A) 100 Patients with CKD in HD, treated or not treated with warfarin Group B) 60 Patients treated with Warfarin with normal kidney function Group C) 60 Healthy Controls Results Compared to healthy donor patients on hemodialysis that were not treated with warfarin had significantly lower tLag (mean tLag 8.2±3.4 vs. 9.7±2.9, p < 0.05), lower tPeak (mean tPeak 14.3±6 vs. 16.2±4.7, p < 0.05), lower Peak (mean Peak 151.8±77.4 vs. 209.2±103.8, p < 0.001) and lower AUC (mean AUC 1624.5±564.4 vs. 2023±489.2, p < 0.001) (