title: Impaired thrombolysis: a novel cardiovascular risk factor in end-stage renal disease.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) patients have an excess cardiovascular risk, above that predicted by traditional risk factor models. Prothrombotic status may contribute to this increased risk. Global thrombotic status assessment, including measurement of occlusion time (OT) and thrombolytic status, may identify vulnerable patients. Our aim was to assess overall thrombotic status in ESRD and relate this to cardiovascular risk.
  
  
  RESULTS
  Thrombotic and thrombolytic status of ESRD patients (n = 216) on haemodialysis was assessed using the Global Thrombosis Test. This novel, near-patient test measures the time required to form (OT) and time required to lyse (lysis time, LT) an occlusive platelet thrombus. Patients were followed-up for 276 ± 166 days for major adverse cardiovascular events (MACE, composite of cardiovascular death, non-fatal MI, or stroke). Peripheral arterial or arterio-venous fistula thrombosis was a secondary endpoint. Occlusion time was reduced (491 ± 177 vs. 378 ± 96 s, P < 0.001) and endogenous thrombolysis was impaired (LT median 1820 vs.1053 s, P < 0.001) in ESRD compared with normal subjects. LT ≥ 3000 s occurred in 42% of ESRD patients, and none of the controls. Impaired endogenous thrombolysis (LT ≥ 3000 s) was strongly associated MACE (HR = 4.25, 95% CI = 1.58-11.46, P = 0.004), non-fatal MI and stroke (HR = 14.28, 95% CI = 1.86-109.90, P = 0.01), and peripheral thrombosis (HR = 9.08, 95% CI = 2.08-39.75, P = 0.003). No association was found between OT and MACE.
  
  
  CONCLUSIONS
  Impaired endogenous thrombolysis is a novel risk factor in ESRD, strongly associated with cardiovascular events.
authors.affiliation: Cardiology Department, East and North Hertfordshire NHS Trust, UK.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Sharma
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.forename: Robert
authors.initials: R
authors.lastname: Kozarski
authors.forename: Christos
authors.initials: C
authors.lastname: Christopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Niespialowska-Steuden
authors.forename: Daniel
authors.initials: D
authors.lastname: Moffat
authors.forename: Diana A
authors.initials: DA
authors.lastname: Gorog
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology*; D002423:Cause of Death; D005260:Female; D063285:Fibrin Clot Lysis Time; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012372:ROC Curve; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis*; D055815:Young Adult