Platelet Count, Anti-Heparin/Platelet Factor 4 Antibodies and Tissue Factor Pathway Inhibitor Plasma Antigen Level in Chronic Dialysis

Luzzatto, Guido; Bertoli, M; Cella, Giuseppe; Fabris, Fabrizio; Zaia, B.; Girolami, Antonio

doi:10.1016/s0049-3848(97)00301-0

Cited by 56 publications

(45 citation statements)

References 24 publications

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“…This low incidence of HIT was also seen in other studies involving medical in patients but the proportion of patients with HIT developing thrombosis was high (50-67%) (16)(17)(18). Analysis of renal patients on haemodialysis also indicate a low incidence of antibody formation (combined incidence 2.6%) with very few patients noted to be thrombocytopenic and none with thrombotic complications (19)(20)(21)(22)(23).…”

Section: Clinical Features Of Hitsupporting

confidence: 69%

Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

Dave¹

2010

E Af Med Jrnl

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Section: Clinical Features Of Hitsupporting

confidence: 69%

Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

Dave¹

2010

E Af Med Jrnl

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“…Five studies have investigated the prevalence of these antibodies in adult patients on chronic hemodialysis [14][15][16][17][18]. The frequency of anti-H/PF4 antibodies in adults has been reported to lie between 0.8 and 12% [14][15][16][17][18], a figure lower than that obtained for other patient groups [1][2][3][4][5]. The actual incidence of HIT and its association with thrombotic events in hemodialysis patients remain unclear, but this condition is thought to be rare [8].…”

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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“…This is a low rate of HIT antibody positivity compared to patients after cardiac or orthopedic surgery. Very few of the dialysis patients were noted to be thrombocytopenic in these six studies, only 6 of 788 patients studied, and none had severe thrombotic complications [9,10,11,12,13,14]. …”

Section: Discussionmentioning

confidence: 99%

Pseudo-Pulmonary Embolism as a Sign of Acute Heparin-Induced Thrombocytopenia in Hemodialysis Patients: Safety of Resuming Heparin after Disappearance of HIT Antibodies

et al. 2006

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Heparin-induced thrombocytopenia (HIT) is a syndrome caused by platelet-activating antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. Thrombocytopenia is the most common clinical feature of HIT. HIT can be considered as a hypercoagulable state, with a high risk of thrombosis. Another feature of HIT is an acute systemic reaction that characteristically begins 5–30 min after receiving an intravenous bolus of unfractionated heparin, such as is commonly given for hemodialysis (HD). Here we present 4 patients who developed acute HIT at or near the start of their chronic HD. All patients were anticoagulated with the low-molecular-weight heparin, nadroparin, for HD. Three of our patients underwent surgery approximately 1–2 weeks before developing HIT. All patients presented with an acute systemic reaction during HD. All patients were treated and further dialyzed with lepirudin. Under this treatment we observed a quick recovery of the platelet count, and patients remained symptom-free. Antibodies against the PF4-heparin complex were detected with a combination of a ‘quick test’ and an enzyme-linked immunosorbent assay test. The likelihood of having HIT previous to the detection of antibodies was estimated with the pre-test probability score criteria. The tests for PF4-heparin antibodies remained positive for an average of 165 days. Three patients underwent a rechallenge with nadroparin after disappearance of the HIT antibodies in their serum. All 3 remained symptomless when they were further hemodialyzed on nadroparin. Our observations indicate that nadroparin can be successfully reintroduced for HD anticoagulation once the patient’s HIT antibodies have disappeared.

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Platelet Count, Anti-Heparin/Platelet Factor 4 Antibodies and Tissue Factor Pathway Inhibitor Plasma Antigen Level in Chronic Dialysis

Cited by 56 publications

References 24 publications

Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

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

Pseudo-Pulmonary Embolism as a Sign of Acute Heparin-Induced Thrombocytopenia in Hemodialysis Patients: Safety of Resuming Heparin after Disappearance of HIT Antibodies

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