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CC BY-NC-ND 4.0 · TH Open 2025; 09: a27199152
DOI: 10.1055/a-2719-9152
Original Article

Fibrinolytic Capacity and Risk of Bleeding in Intensive Care Patients with Acute Kidney Injury

Authors

  • Rasmus R. Mikkelsen

    1   Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Group, Aarhus University Hospital, Aarhus, Denmark

  • Christine L. Hvas

    2   Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
    3   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

  • Tua Gyldenholm

    1   Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Group, Aarhus University Hospital, Aarhus, Denmark
    3   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

  • Julie Brogaard Larsen

    1   Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Group, Aarhus University Hospital, Aarhus, Denmark
    3   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Funding This project received funding from Karen Elise Jensens Fond, Direktør Jakob Madsens og Hustru Olga Madsens Fond, and the Graduate School of Health, Aarhus University.
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Abstract

Background

Acute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with increased bleeding risk. The impact of fibrinolysis in AKI-related bleeding has not been explored previously.

Objectives

(1) Compare fibrinolytic capacity in ICU patients with and without AKI. (2) Investigate the association between fibrinolytic capacity, as well as other laboratory and clinical variables, and bleeding within the first 7 ICU days in AKI patients.

Methods

Adult ICU patients were prospectively enrolled and stratified by AKI presence and severity at ICU admission. On the morning after admission, fibrinolytic capacity was assessed using a modified rotational thromboelastometry (ROTEM-tPA) assay. The primary outcome was the difference in ROTEM-tPA lysis time on day 1 of ICU admission between AKI and non-AKI patients.

Results

AKI patients (n = 160) had more bleedings and higher 30-day mortality than non-AKI patients (n = 99). ROTEM-tPA analysis showed progressively impaired fibrinolysis with increasing AKI severity. AKI stage 3 patients (n = 53) demonstrated significant impairment across all fibrinolysis parameters compared with non-AKI patients. Among AKI stage 2 to 3 patients (n = 106), bleeding patients (n = 61) had more pronounced fibrinolytic impairment than non-bleeding patients (n = 45). Bleeding risk in AKI stage 2 to 3 was associated with increasing severity of illness (OR: 1.21 (95%CI 1.04–1.42) per 1 point increase in non-renal Sequential Organ Failure Assessment (SOFA) score, p = 0.01).

Conclusions

AKI severity in ICU patients was associated with progressively impaired fibrinolysis. Despite this, AKI patients had more bleedings within the first 7 days of ICU admission.

Keywords

acute kidney injury - blood coagulation tests - critical care - fibrinolysis - thrombelastography

Supplementary Material



Publication History

Received: 19 September 2025

Accepted: 22 September 2025

Accepted Manuscript online:
13 October 2025

Article published online:
29 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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Bibliographical Record
Rasmus R. Mikkelsen, Christine L. Hvas, Tua Gyldenholm, Julie Brogaard Larsen. Fibrinolytic Capacity and Risk of Bleeding in Intensive Care Patients with Acute Kidney Injury. TH Open 2025; 09: a27199152.
DOI: 10.1055/a-2719-9152
 

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