Eg. Pivalizza et al., PERIOPERATIVE HYPERCOAGULABILITY IN UREMIC PATIENTS - A VISCOELASTIC STUDY, Journal of clinical anesthesia, 9(6), 1997, pp. 442-445
Study Objective: To examine whole blood coagulation in uremic patients
presenting for surgery with the thromboelastogram and the Sonoclot an
alyzer. Design: Prospective, observational study. Setting: Operating r
ooms of a university-affiliated hospital. Patients: 30 ASA physical st
atus II and III patients with chronic renal failure, and 30 age-matche
d and gender-matched patients with normal renal function, presenting f
or elective surgery. Interventions: Blood sampling for thromboelastogr
aph and Sonoclot analysis immediately after anesthetic induction, prio
r to surgical incision. Measurements and Main Results: Thromboelastogr
aphic indices of coagulation, reflecting coagulation factor function (
R time), fibrinogen-platelet interaction (K time and alpha angle), and
qualitative platelet function (maximum amplitude) were hypercoagulabl
e in the uremic group compared with the control group (p < 0.05). Fibr
inolysis (%) teas decreased in the uremic group (p < 0.05). Fibrin for
mation (initial slope) and platelet function (time to peak) of the Son
oclot trace also were hypercoagulable in the uremic group (p < 0.05).
Conclusions: The high incidence of arteriovenous graft and fistulae th
romboses in uremic patients belies in vitro laboratory evidence of pla
telet dysfunction. We have demonstrated perioperative hypercoagulabili
ty in uremic patients with viscoelastic measures of whole blood coagul
ation. These data suggest that traditional concern for coagulopathy an
d platelet dysfunction in uremic patients may require re-assessment in
light of this ''pro-thrombotic'' state. (C) 1997 by Elsevier Science
Inc. .