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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2025; 17(12): 112046
Published online Dec 26, 2025. doi: 10.4330/wjc.v17.i12.112046
Published online Dec 26, 2025. doi: 10.4330/wjc.v17.i12.112046
Bleeding prediction by rotational thromboelastometry in chronic hemodialysis patients with non-valvular atrial fibrillation on apixaban
Dimitra Bacharaki, Aggeliki Sardeli, Petros Nikolopoulos, Sophia Lionaki, Clinical and Interventional Nephrology Unit, Attikon University General Hospital, Chaidari 12462, Attikí, Greece
Elias Kyriakou, Aristarchos Poulis, Argyrios Tsantes, Department of Laboratory Hematology, Hemostasis and Transfusion Services, Attikon University General Hospital, Chaidari 12462, Attikí, Greece
George Triantaphyllis, Emmanouel Haviaras, Hemodialysis Unit, Medifil AE Private Nephrological Centre, Peristeri 12132, Attikí, Greece
Athina Drakou, Eleni Triantou, Nephrology Unit, Henry Dunant Hospital Center, Athens 11526, Attikí, Greece
Fotis Makris, Alexandra Fatourou, Hemodialysis Unit, Mesogeios Palaiou Falirou, Palaio Faliro 17564, Attikí, Greece
Eleni Spanou, Hemodialysis Unit, Protypo Nephrology Center Piraeus, Piraeus 18454, Attikí, Greece
John Kyriazis, Department of Nephrology, General Hospital of Chios, Chios 82100, Chios Regional Unit, Greece
Author contributions: Bacharaki D and Kyriakou E participated in study design; Bacharaki D conceived the idea, drafted the manuscript and revised the manuscript for intellectual content; Kyriakou E, Poulis A, and Tsantes A performed lab analyses; Kyriakou E, Kyriazis J, and Lionaki S contributed to the writing of the manuscript; Sardeli A, Triantaphyllis G, Drakou A, Makris F, Spanou E, Triantou E, Haviaras E, Fatourou A participated in patient enrolment and collected clinical data; Nikolopoulos P contributed to the editing of tables and figures; Kyriazis J performed statistical analysis; Lionaki S revised the manuscript for language and intellectual content. All authors gave approval for the final version to be submitted.
Institutional review board statement: The study was reviewed and approved by the Attikon University General Hospital Institutional Review Board (Approval number 50/01-02-2021).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data will be available upon reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitra Bacharaki, MD, PhD Clinical and Interventional Nephrology Unit, Attikon University General Hospital, Rimini 1, Chaidari 12462, Attikí, Greece.
Received: July 17, 2025
Revised: August 18, 2025
Accepted: November 4, 2025
Published online: December 26, 2025
Processing time: 161 Days and 16.3 Hours
Revised: August 18, 2025
Accepted: November 4, 2025
Published online: December 26, 2025
Processing time: 161 Days and 16.3 Hours
Core Tip
Core Tip: The clinical dilemma of anticoagulation choice in hemodialysis patients with non-valvular atrial fibrillation is still unresolved. Apixaban use yields so far conflicting results. We conducted a pilot study in hemodialysis patients with non-valvular atrial fibrillation on apixaban, where we measured once on a non-dialysis day drug levels and rotational thromboelastometry before and after the morning pill under the dosing regimen used in clinical practice. Then we registered bleeding and thrombotic events. We found that clotting time by rotational thromboelastometry EXTEM after the morning pill was associated with bleeding events and thus could potentially be used as a prediction tool.