Anti-Heparin-Platelet Factor 4 Antibody is a Risk Factor for Vascular Access Obstruction in Patients Undergoing Hemodialysis

Abstract

Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The prevalence of anti-heparin-platelet factor 4 antibodies was higher in hemodialysis patients than in normal subjects (8.8 vs 0.0%, p<0.05). The number of past episodes of vascular access obstruction per year was significantly higher in the anti-heparin-platelet factor 4 antibody positive group than antibody negative group. Anti-heparin-platelet factor 4 antibody positive patients experienced more frequent vascular access obstructions than control subjects. In conclusion, anti-heparin-platelet factor 4 antibody might be a risk factor for vascular access obstructions in patients with end-stage renal disease on maintenance hemodialysis.

Anti-heparin-platelet factor 4 antibodies are associated with arterial and venous thrombosis in patients with maintenance haemodialysis

“…Our study confirms that high prevalence of IgG-PF4/H antibodies existed in Chinese patients with haemodialysis, while previous studies found the prevalence ranged from 0 to 12% (3, [8][9][10][11]. The largest and the most comprehensive examination found the prevalence was 1% (5/464) in Caucasians and 17% (4/24) in African-American people, which indicates a difference in races (10).…”

“…Previous studies have shown that serum albumin level was not only a predictor of nutritional status (13), but also a strong predictor of cardiovascular death in maintenance haemodialysis patients (14). This parallel trend further indicates that the presence of IgG-PF4/H antibodies was associated with a significant increase in mortality for patients on maintenance haemodialysis (11).…”

Platelet factor 4/heparin antibody (IgG/M/A) in healthy subjects: a literature analysis of commercial immunoassay results

“…In three of these seven articles, the described assay ultimately served as basis of a commercial assay [12,13,19]. The literature set comprised the remaining 11 articles [10,16,17,[20][21][22][23][24][25][26][27], each of which reported the prevalence of PF4/heparin antibodies in healthy subjects, as assessed by a commercial immunoassay according to manufacturer's directions (Table 1). …”

“…In the literature set (Table 1), the PF4/heparin ELISA was used in nine studies [10,16,17,[20][21][22][23][24]26], the PF4/PVS ELISA in three studies [17,24,25], and the PF4/heparin PGIA in three studies [17,24,27]. No study used the PIFA.…”

Temporality of heparin-induced antibodies: a retrospective study in outpatients undergoing hemodialysis on unfractionated heparin

“…There was no significant association between HIA and thrombocytopenia, AVTE or access thrombosis. It has been suggested that asymptomatic but detectable HIA contributes to hypercoagulability and access thrombosis in HD [ 27 , 30 , 43 ]. However, neither our study nor others [ 26 , 32 ] strongly corroborate this finding.…”