Hemostatic Disorder of Uremia: The Platelet Defect, Main Determinant of the Prolonged Bleeding Time, Is Correlated with Indices of Activation of Coagulation and Fibrinolysis

Diego Mezzano; Rodrigo Tagle; Olga Panes; Marcos Pérez; Patricio Downey; Blanca Muñoz; Eduardo Aranda; Pliar Bajra; Sergio Thambo; Fernando González; Sergio Mezzano; Jaime Pereira

doi:10.1055/s-0038-1650576

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1996; 76(03): 312-321
DOI: 10.1055/s-0038-1650576

Original Article

Schattauer GmbH Stuttgart

Hemostatic Disorder of Uremia: The Platelet Defect, Main Determinant of the Prolonged Bleeding Time, Is Correlated with Indices of Activation of Coagulation and Fibrinolysis

Diego Mezzano

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Rodrigo Tagle

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Olga Panes

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Marcos Pérez

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Patricio Downey

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Blanca Muñoz

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Eduardo Aranda

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Pliar Bajra

²The Department of Exper. Medicine, Valdivia, Chile

,

Sergio Thambo

³The Department of Nephrology, School of Medicine, University of Chile, Chile

,

Fernando González

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

,

Sergio Mezzano

⁴Santiago and Division of Nephrology, School of Medicine, Austral University, Valdivia, Chile

,

Jaime Pereira

¹The Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University, Valdivia, Chile

› Author Affiliations

Abstract

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Summary

Several parameters of primary hemostasis and markers of activation of coagulation and fibrinolysis were measured in 48 patients with severe (creatinine clearance <20 ml/min) chronic renal failure (CRF) without dialysis and diseases or drugs affecting hemostasis. Bleeding time (BT) was prolonged in 25/48 patients, and was correlated with age of patients, severity of renal failure, hematocrit, impairment in platelet aggregation-secretion and decrease in platelet ATP content. Defects in von Willebrand factor played no role in the prolongation of the BT. Multivariate analysis showed that only platelet dysfunction and severity of renal disease were independent predictors of the BT in uremia. The platelet functional disorder was significantly correlated with a reduction in platelet ATP and ADP.

High levels of plasma thrombin-antithrombin complexes (TAT), prothrombin fragment F₁₊₂, fibrinogen and factor VIIc were observed in patients with CRF, as described in prethrombotic states. Plasmin-antiplasmin complexes (PAP), fibrinogen and fibrin degradation products (FgDP, FnDP) were significantly increased, and the activity of plasminogen activator inhibitor (PAI-1) was slightly reduced, denoting an activation of fibrinolysis.

A negative correlation was found between platelet levels of ATP and ADP with plasma TAT, F₁₊₂ and PAP. Furthermore, plasma PAI-1 activity was negatively correlated with the BT and was lower in patients with prolonged BT as compared with controls and patients with normal BT. These links between primary hemostasis and activation of coagulation and fibrinolysis suggest that increased intravascular generation of thrombin and/or plasmin is an important mediator of the defects in primary hemostasis, prolongation of the BT and, probably, bleeding in CRF.

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References

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