Evaluation of Thrombelastography Versus Non-Viscoelastic Assays to Predict Hypercoagulability in Pediatric Chronic Kidney Disease: A Pilot Study (.75 Class A CE)

Chronic kidney disease (CKD) induces a hypercoagulable milieu associated with 5% of all pediatric venous thromboembolism (VTE) diagnoses; the highest risk being imposed upon individuals with polymorbidity. VTE is associated with a 2-fold increase in mortality and exponentially higher rates of healthcare expenditure. Because VTE is a low-incidence but high-impact complication of CKD, accurate risk stratification is paramount. Mechanisms underlying this coagulopathy remain veiled, but likely involve aberrations across the hemostatic and fibrinolytic systems. Current literature suggests a hypercoagulability mediated by exaggerated factor 8 and endothelial damage, alterations in fibrinogen, and diminutive fibrinolysis. Elucidating these characteristics through coagulation testing proves difficult, as conventional clotting tests undergo centrifugation and much of the contributing cellular debris found in whole blood is lost. Viscoelastic assays provide qualitative measures for hemostatic milestones in whole blood, thereby preserving cellular debris and additional factors which promote clot formation. We propose a comparison of thrombelastography, a type of viscoelastic assay, against conventional clotting tests as a modality for identifying hypercoagulability in pediatric patients with CKD that would otherwise remain obscured.