Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients

Mureebe, Leila; Coats, Richard D.; Silliman, W.R.

doi:10.1016/j.jvs.2004.12.019

Cited by 9 publications

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“…These complications and clotting in the extracorporeal hemodialysis circuit are common features of HIT [8,22,23,25]. In addition, anti-H/PF4 antibodies have been shown to be correlated with morbidity and mortality in hemodialysis patients [37,38].…”

Section: Discussionmentioning

confidence: 99%

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

et al. 2006

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Heparin, which is used at high doses in hemodialysis patients, may induce antibodies favoring thromboembolic complications. We prospectively investigated the prevalence of heparininduced platelet-reactive antibodies in a cohort of 38 pediatric hemodialysis patients, by means of heparin/platelet factor 4 (H/PF4) ELISA and heparin-induced platelet activation assay (HIPA). We also assessed other acquired and congenital hypercoagulable states. Heparin-induced antibodies were detected in 13 and 21% of patients with HIPA and ELISA, respectively. Anti-H/PF4 antibodies were negatively correlated with the number of hemodialysis sessions. These antibodies disappeared after a median time of 6 months despite continuing heparin treatment. The prevalence of antiphospholipid antibodies was 21% (anticardiolipin 10.5%, anti-b2GPI 13%, and lupus anticoagulant 5%). Blood levels of homocysteine, factor VIII, and fibrinogen were significantly higher and factor II levels were significantly lower in hemodialysis patients than in controls, whereas factor VII, factor IX, and natural coagulation inhibitor levels were similar in patients and controls. Overall, 26 of 38 patients had at least one biomarker of hypercoagulability, but only 1 patient, without anti-H/PF4 antibodies, presented with thrombosis. In conclusion, heparin induces the transient production of anti-H/PF4 antibodies in children undergoing hemodialysis, but other abnormalities probably contribute to hypercoagulability. These findings may help to improve the diagnosis and management of thrombotic events in hemodialysis patients. Am. J. Hematol. 81:328-334, 2006. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

et al. 2006

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“…Chronic dialysis patients who are repeatedly exposed to heparin are rarely at risk of developing heparin-induced thrombocytopenia, and show high-level mortality due to atherosclerotic cardiovascular events [28]. Sometimes they have indications for cardiovascular surgery on non-dialysis sessions.…”

Section: Cardiovascular Surgery In Patients With Chronic Hemodialysismentioning

confidence: 99%

Heparin-Induced Thrombocytopenia and Hemodialysis

Matsuo¹

2013

J Blood Disord Transfus

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Hemodialysis-related-heparin-induced thrombocytopenia (HD-HIT) is a drug-induced, immunoglobulinmediated disorder that it is suspected in dialysis patients with an unexpected fall in the platelet count, and/or unexplained thrombotic events, particularly visible clotting in the circuit under an adequate heparin dose, that begins between 5 and 10 days (nadir between 7 and 30 days, mostly by the third to fifth session) after heparin initiation. Although a positive result for anti-PF4/heparin complex antibodies (HIT antibodies) is presumably detected by sensitive ELISA, the diagnosis should be confirmed, whenever possible, using a functional assay. Immediately after the clinical suspicion of HIT, all sources of heparin should be discontinued including heparin used to flush or lock catheters. Alternative non-heparin anticoagulants, preferentially a direct thrombin inhibitor, should be restarted for dialysis. Early treatment is important as thrombus formation including a clotting circuit may complicate at a high rate within 30 days after the cessation of heparin. Argatroban, a synthetic direct thrombin inhibitor, as an alternative to heparin, must contribute to the rapid recovery of the platelet count and disappearance of visible circuit clotting. A steady decreasing of the ELISA titers can be expected after heparin discontinuation. A negative seroconversion of HIT antibodies is usually observed by ~30 to more than 100 days after discontinuation. Re-exposure to heparin can be selected at the same dose of heparin as used before the onset of HIT. A small peak of HIT antibodies may often appear after exposure, but a follow-up of the antibody titers shows that they not reach a threshold to induce the recurrence of HIT. When HD-HIT patients exhibit a high index of thrombotic formation or worsening thrombosis, the same alternative anticoagulant therapy may be needed on non-session days.

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“…Chronic dialysis patients who repeatedly exposed to heparin rarely are at risk of developing HIT, show high-level mortality due to atherosclerotic cardiovascular events (Mureebe et al, 2004). Sometimes they have indications for cardiovascular surgery on non-dialysis sessions.…”

Section: Cardiovascular Surgery With Chronic Hemodialysismentioning

confidence: 99%

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

Matsuo¹

2012

Renal Failure - The Facts

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Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients

Cited by 9 publications

References 0 publications

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

Heparin-Induced Thrombocytopenia and Hemodialysis

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

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