Thrombotic complications resulting from hypercoagulable states in chronic hemodialysis vascular access11No competing interests declared.

LeSar, Christopher J.; Merrick, Hollis W.; Smith, Matthew R.

doi:10.1016/s1072-7515(99)00086-1

Cited by 73 publications

(51 citation statements)

References 20 publications

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“…In our series of patients, factor VIII and fibrinogen levels were significantly higher in hemodialysis patients than in controls, whereas factor VII and factor IX levels were similar in patients and controls. In contrast to previous studies [7,33,34], we found no significant difference in the levels of natural coagulation inhibitors (AT, proteins C and S) between hemodialysis patients and controls. Decreases in the levels of natural coagulation inhibitors may result from hemodialysis itself or the type of underlying nephropathy, particularly for nephrotic syndrome [7,33,34].…”

Section: Discussioncontrasting

confidence: 99%

“…Thromboembolic events are a major cause of mortality and morbidity in hemodialysis patients [6], and there is a growing evidence that underlying hypercoagulable states may increase the risk of such events [7]. Patients undergoing hemodialysis are treated with heparin over long periods and therefore have a theoretically high risk of developing HIT.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

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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“…Some patients with ESRD carry a particularly high risk for recurring access thrombosis or stenosis (5,28,29). These patients with hypercoagulable states or combined thrombophilia should be preoperatively identified to tailor antithrombotic therapy and intensify surveillance, especially during the first, most vulnerable months after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on inherited or acquired thrombophilia in access thrombosis are scarce among patients with ESRD, and the results are contradictory. This is due to limited patient numbers, retrospective thrombophilia screening, and differences in definition and inclusion of individual types of thrombophilia (4)(5)(6)(7)(8)(9)(10)(11). One large retrospective study of 419 patients undergoing HD found at least one thrombophilic disorder in 43% of patients with ESRD, and any thrombophilic disorder increased the risk for access thrombosis (2).…”

Section: Introductionmentioning

confidence: 99%

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Salmela

Hartman²,

Peltonen³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities.Design, setting, participants, & measurements This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and D-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models.Results Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF.Conclusions Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

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“…Presence of a lupus anticoagulant was found in 16.5% of 97 patients with end-stage renal disease and was associated with a higher frequency of access thrombosis (62% vs 26%). 40 Thrombophilic risk factors were moderately associated with access thrombosis (OR < 3) in a case control study by Knoll. 39 FVL, elevated factor VIII levels, elevated homocysteine and elevated lipoprotein (a) were associated with excess thrombosis.…”

Section: Hemodialysis Vascular Access Thrombosismentioning

confidence: 96%

Management of Hereditary Hypercoagulable Disorders

Bockenstedt¹

2006

Hematology

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The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome. Initial DecisionsThe clinical management of individuals with hereditary hypercoagulable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism (VTE) to a more intricate, individualized risk-benefit analysis as the complexity of interactions of acquired and hereditary factors that determine the predilection to thrombosis are now recognized. Important behind stratifying risk of recurrent events is the necessity of correctly identifying hereditary thrombophilic disorders, especially in circumstances in which laboratory results, e.g., mildly low antithrombin III (ATIII) or protein S levels, may be more indicative of a temporary acquired deficiency. The relevance of thrombophilic testing is debated, but most clinicians agree that prothrombotic assessment should be considered in individuals with unprovoked thrombosis at age less than 40 years, individuals who have had thrombosis at an unusual anatomic site or who have had repeated thromboses, or when the family history suggests multiple affected individuals. For review of the laboratory assessment of thrombophilia see references [1][2][3] . The following discussion is not meant to be comprehensive, but serves to highlight a few of the clinical management decisions important in the care of the thrombophilic patient. Therapeutic considerations involving individuals with antiphospholipid syndrome (APS) will be included where pertinent. Duration of anticoagulant therapyThe decision to extend therapy beyond 6-12 months after an incident thrombotic event must be made on an individual basis. Patients with a transient risk factor such as oral contraceptive use, postsurgical state or limb immobilization have a low risk of recurrence of thrombosis once anticoagulation has been completed. (For review see 4,5 .) Identifying the individual with moderate to high risk of recurrent thrombosis is important to prevent the unnecessary risk of hemorrhage from long-term anticoagulation. From studies of patients with a first VTE (both with and without diagnosed hereditary thrombophilia), one third of patients with unprovoked VTE will have a reoccurrence over the next 10 years and 6% of patients with VTE develop postphlebitic syndrom...

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Thrombotic complications resulting from hypercoagulable states in chronic hemodialysis vascular access11No competing interests declared.

Cited by 73 publications

References 20 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

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Management of Hereditary Hypercoagulable Disorders

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