Activated Protein C-Resistance Determination and Vascular Access Thrombosis in Populations with High Prevalence of Factor V Leiden

Abstract

Background/Aims: Factor V Leiden heterozygosity occurs in 3-8% of the general European and US populations. Activated protein C resistance (APC-R) - a non-molecular laboratory test - can efficiently demonstrate the presence of this mutation and can be performed on most coagulation analyzers. On the other hand, fistula or graft thrombosis is a common and costly complication in hemodialysis patients. Our aim was to establish the value of APC-R determination in hemodialysis patients by assessing the risk of access thrombosis in patients with increased APC-R. Methods: A total of 133 patients (81 men, mean age 64.5 ± 14.9 years and 52 women, mean age 63.6 ± 15 years) were selected. Participants were divided into 2 groups: those with access thrombosis (54 patients, 40.6%) and those with no access thrombosis (79 patients, 59.4%), and they were tested for the most common congenital or acquired thrombophilia risk factors. Results: Overall, 12 patients (9%) had an increased APC-R and 10 of them had at least 1 episode of access thrombosis (83.3%). Univariate analysis to estimate crude odds ratio (OR) showed an OR of 8.8 (95% CI 1.8-41.8) times higher risk for access thrombosis in these patients. No significant differences were found after adjusting for age, hypertension, diabetes mellitus, coronary artery disease, cerebrovascular disease, peripheral arterial disease and malignancy. Sex was also a factor influencing thrombosis, presenting a higher OR for women (OR 2.2, 95% CI 1.1-4.4). Conclusion: This study revealed a significant association between access thrombosis and increased APC-R in hemodialysis patients. This indicates that the determination of APC-R should be considered - especially, in populations with a high prevalence of Factor V Leiden - as proper anticoagulant therapy in these patients may reduce the risk of access thrombosis.

Diabetes decreases patency of tunneled catheters in hemodialysis patients after first effective thrombolysis with urokinase

“…It seems that not all known factors increasing blood clotting (e.g., cancers, some autoimmune diseases, obesity, thrombophilia, respiratory and heart failure – NYHA class III and IV) are important for maintaining patency of catheter. Moreover, especially in a part of patients with recurrent thrombosis undiagnosed thrombophilia can be anticipated [ 11 ].…”

Impact of monthly arteriovenous fistula flow surveillance on hemodialysis access thrombosis and loss

“…The sustained maintenance of VA patency without flow dysfunction is essential and can affect the prognosis of patients undergoing HD. 1 Thus, several studies have assessed the risk factors associated with VA thrombosis and/or loss and revealed that many risk factors such as age, 21 sex, 22 the presence of DM and hypertension, 3,15,21 the use of drugs with antiplatelet and/or vascular antiproliferative activity, 23 and AVF location 9 Our study had several limitations. First, it was a retrospective, single-center, observational study, which might not apply to the general population with ESRD undergoing HD.…”