Key result
In warfarinised patients with atrial fibrillation, deteriorating renal function was significantly associated with altered whole blood and fibrin clot properties (P<0.001), but had no effect on INR.
Why the study?
Does renal function affect whole blood and fibrin clot formation in warfarinised atrial fibrillation patients?
Cross-Sectional (n=200)
Does renal function affect whole blood and fibrin clot formation in warfarinised atrial fibrillation patients?
In warfarinised AF patients, deteriorating renal function is associated with altered clot structure and function independent of INR, which may contribute to excess thrombosis or hemorrhage.
Altered clot properties with renal decline in warfarinized AF may affect risk; leaves open whether INR-guided therapy needs supplementation.
OBJECTIVE: Atrial fibrillation (AF) brings a risk of thrombosis, requiring oral coagulation, and is associated with renal impairment. The two processes may be linked, as altered fibrin clot structure is present in end-stage renal failure. We hypothesised that progressively deteriorating renal function is linked to altered whole blood and fibrin clot properties and fibrinolysis. METHODS: Thrombogenesis and fibrinolysis in 200 warfarinised AF patients was assessed by thromboelastography (TEG), a micro-plate assay (MPA) and the international normalized ratio (INR). Renal function was determined by creatinine clearance and two versions of the estimated glomerular filtration rate (eGFR). RESULTS: Two TEG indices independently reflecting thrombogenesis were linked to creatinine clearance (p < 0.01), whilst a third, reflecting clot strength, was linked to the eGFR (p < 0.001). MPA indices of thrombogenesis and clot density (p < 0.001), and an index of fibrinolysis (p < 0.001) were linked to the eGFR. The time for 50% of the fibrin clot to lyse was linked to creatinine clearance (p = 0.001). The INR was unrelated to any renal function index, and the CHA2DS2VASc score was unrelated to any index. CONCLUSION: In warfarinised AF patients, renal function is linked to whole blood clot and fibrin clot formation, structure and dissolution, but has no effect on the INR. Key messages Despite oral anticoagulation, patients with atrial fibrillation (AF) still suffer from stroke and venous thromboembolism. The effect of renal function in warfarinised patients with AF is unknown and may account for excess thrombosis and/or haemorrhage. Using two different laboratory methods, our data point to an effect of renal function on clot structure and function that is independent of an effect of warfarin.
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Lau et al. (2016) conducted a cross-sectional in Atrial fibrillation (n=200). Renal impairment was evaluated on Thrombogenesis, fibrinolysis, and clot strength indices measured by TEG and MPA (p=<0.001). In warfarinised patients with atrial fibrillation, deteriorating renal function was significantly associated with altered whole blood and fibrin clot properties (P<0.001), but had no effect on INR.
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