Thromboelastographic Profile of Patients with Hyperparathyroidism Secondary to Chronic Kidney Failure Submitted to Total Parathyroidectomy

Abstract

Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.

Effect of hyperparathyroidism on coagulation: a global assessment by modified rotation thromboelastogram (ROTEM)

“…All studies concluded with a proposal of studies with more patients, on the coagulation-fibrinolytic function of patients with PHPT. There are ongoing studies investigating the effect of serum calcium levels on platelet aggregation, coagulation, and TEG parameters in healthy people [8,19]. Recent study investigated the platelet functions of patients with hyperparathyroidism using platelet aggregation tests and determined that neither primary and secondary hyperparathyroidism nor serum calcium levels significantly affected platelet functions [20].…”

“…Studies evaluating coagulation disorders in patients with primary hyperparathyroidism are limited, and it has not yet been fully assessed whether their effects on coagulation are due to hypercalcemia or primary hyperparathyroidism. The results of a limited number of studies do not always support each other [3][4][5][6][7][8]. Hypercalcemia may cause thrombosis due to vascular smooth muscle contraction and vasoconstriction or platelet aggregation and coagulation factors.…”

“…The literature contains studies about the relationship between hyperparathyroidism and thrombosis, which reveal hypercoagulability and hypofibrinogenemia [3][4][5][6][7]. In addition to high calcium status, a tendency to coagulation is shown in secondary hyperparathyroidism [8]. Studies evaluating coagulation disorders in patients with primary hyperparathyroidism are limited, and it has not yet been fully assessed whether their effects on coagulation are due to hypercalcemia or primary hyperparathyroidism.…”

Association between hypocalcemia and rivaroxaban in coagulation disorders: a case report

“…Therefore, there should be constant concern with the possibility of increased bleeding during surgery and the use of thromboprophylaxis, including thrombosis of the arteriovenous fistula. (6) Lately, the use of rivaroxaban has been extended beyond the procedural indications, because the drug is considered safe, with efficacy comparable to low molecular weight heparin and warfarin, besides not need for laboratory control tests. Its use does not require dose adjustments for weight, age or sex, and it does not present interactions with food, which improves its absorption and bioavailability when taken at meals.…”