Comparison of thrombodynamic methods and routine hemostasis tests in the evaluation of hypercoagulable syndrome in chronic glomerulonephritis

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Abstract

Background. Nephrotic syndrome (NS) is associated with a high risk of thrombotic complications. In this group of patients, routine local tests for assessing hemostasis do not accurately reflect hypercoagulable state. Global functional tests for assessing hemostasis, including thrombodynamics (TD), are considered promising for assessing disorders in the blood coagulation system of these patients.

Aim. To compare the rate of hypercoagulability according to routine hemostatic tests and TD and to evaluate the factors associated with increased risk of thrombotic complications in patients with chronic glomerulonephritis (CGN).

Materials and methods. The study included 94 patients with active CGN who were not receiving anticoagulant therapy; 63 (80.3%) patients had NS, and 31 (19.7%) had active CGN without NS. Hemostasis parameters were assessed using local coagulation tests and TD test. Using logistic regression analysis, factors associated with the risk of thrombosis were assessed.

Results. Of the 94 patients with active CGN in 63 without preventive anticoagulant therapy, hypercoagulability according to routine tests was detected in 6 (9.5%) patients with NS and in 3 (9.7%) patients without NS (p<0.05). Hypercoagulability according to the TD test was detected in 24 (53.9%) patients with NS and in 5 (32.2%) without NS (p<0.05). The formation of spontaneous clots was observed in 29 (30.9%) of patients with CGN, most of them 24 (83%) with NS. 10.6% of patients in our cohort experienced thromboembolic events. The risk of thromboembolic events according to the univariate regression analysis was associated with older age, higher lipid levels, use of glucocorticosteroids and detection of spontaneous clots by the TD test. No association of thromboembolic events with abnormalities in routine hemostasis tests was obtained.

Conclusion. In patients with CGN with nephrotic syndrome, hypercoagulability is detected in 9.5% of cases with routine coagulation tests and in 53.9% of cases with TD test. Detection of spontaneous clots by TD test is associated with a risk of thromboembolic events.

About the authors

Natalia V. Chebotareva

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0003-2128-8560

д-р мед. наук, проф., каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

Evgenia A. Kharionovskaya

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0009-0008-8777-5007

клин. ординатор каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

Evgenia A. Biryukova

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0009-0005-8284-3136

студентка фак-та педиатрии, каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

Svetlana A. Berns

National Medical Research Center for Therapy and Preventive Medicine

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0003-1002-1895

д-р мед. наук, проф., зав. каф. терапии и общей практики Института профессионального образования и аккредитации

Russian Federation, Moscow

Tatiana A. Vuimo

Center for Theoretical Problems of Physico-Chemical Pharmacology

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0003-3491-1884

канд. биол. наук, аналитик-исследователь лаб. молекулярных механизмов гемостаза

Russian Federation, Moscow

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