Thrombophilia Associated with Early Post-angioplasty Thrombosis of Dialysis Vascular Access

Chen, Tsung-Yan; Lin, Lin; Hsieh, Mu-Yang; Chen, Chiu-Hui; Chen, Meng-Kan; Wu, Chih‐Cheng

doi:10.1007/s00270-018-2046-5

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…antiphosphospholipid antibodes at least after 12 weeks is recommended [34]. The proportion of HD-patients positive for antiphospholipid antibodies was also within the range reported by others for this patient group [10, 32, 35–38]. In summary, this suggests that we examined a quite representative group of HD-patients.…”

Section: Discussionsupporting

confidence: 79%

Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up

et al. 2019

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ObjectiveThrombophilic risk factors (TRFs) occur rather frequently in hemodialysis (HD) patients. However, little is known about their significance in HD patients, besides their potential impact on arteriovenous (AV) access failure, with varying results. We examined the effects of a wide variety of TRFs on both early AV fistula occlusion and survival among HD patients in long-term follow-up.MethodsIn this single-center, observational study, 70 consecutive HD patients from our dialysis center were examined with respect to shunt occlusion within the first 2 years after fistula creation and patient survival in a long-term follow-up (at least 16 years). We examined the presence of factor V, prothrombin, and MTHFR mutations using real-time fluorescence polymerase chain reaction. Furthermore, antithrombin (AT), protein C, protein S, and antiphospholipid antibodies (APL-Abs) were assessed.ResultsAmong the 70 patients, 32 had MTHFR mutations, 10 had heterozygous factor V Leiden mutations, 4 had prothrombin mutations, 4 had protein S deficiency, 2 had protein C deficiency, 9 had AT deficiency, and 14 had APL-Abs. 40 patients had shunt occlusion. TRFs were associated with a significantly increased risk for shunt thrombosis (P<0.02). Kaplan–Meier analysis with a log-rank test revealed significantly shorter survival in HD patients with TRFs (P<0.02). Cox regression analysis showed that the presence of TRFs (P<0.05; hazard ratio, 1.94; 95% CI: 1.07–3.56), but not early shunt occlusion, was associated with short patient survival.ConclusionsTRFs in hemodialysis patients have a strong impact on patient survival and early AV fistula failure; however, patient survival is not significantly affected by early shunt occlusion.

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Section: Discussionsupporting

confidence: 79%

Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up

et al. 2019

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“…Furthermore, the average 3-month patency rate was 21% (fistula) to 60% (graft) following the management of non-thrombosed accesses according to the review in SIR guidelines 4 . Consequently, factors other than stenoses, such as thrombophilia, haemostasis, hypotension, or degenerative change of the access, may play a more prominent role in early thrombosis events after interventions 17,18 . The underlying causes should be comprehensively evaluated before referral for surgical revision, as suggested by the guidelines, for patients presenting with early thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Temporal distribution and biological determinants of thrombotic events after interventions for dialysis vascular access

Hsieh

Lee

et al. 2019

Sci Rep

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Endovascular therapy is the principal therapy for haemodialysis vascular access dysfunction. Nonetheless, the incidence and determinants of post-intervention thrombotic events are unclear. This prospective cohort study evaluated the incidence and timing of thrombotic events after endovascular therapy and analysed the clinical, angiographic, and biological determinants of thrombosis. Of the 236 patients enrolled, 91 experienced post-intervention thrombotic events within 1 year. The 1-year thrombosis-free patency was 28% for thrombosed accesses, 53% for non-thrombosed grafts, and 78% for non-thrombosed fistulas. Forty-one of the 91 thrombotic events (45%) occurred within 3 months post-intervention. In the univariate analysis, early thrombosis was associated with longer haemodialysis duration (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.01–1.02), graft access (HR, 7.69; 95% CI, 3.33–20.0), multiple stenoses (HR, 2.69; 95% CI, 1.36–5.37), and high indoxyl sulphate (IS) levels (HR, 1.55; 95% CI, 1.32–1.82). Late thrombosis was associated with diabetes (HR, 1.89; 95% CI, 1.01–3.57), cardiovascular disease (HR, 2.38; 95% CI, 1.27–4.54), and endothelial progenitor cell counts (HR, 0.97; 95% CI, 0.93–0.99). After multivariate adjustment, high IS was the major predisposing factor for early post-intervention thrombosis (HR, 1.41; 95% CI, 1.18–1.69). Our findings suggest that measures to decrease IS could target the most critical period of thrombosis.

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“…Sixty‐three percent of these patients had at least one thrombophilic factor, compared with 15 patients (37%) in the control group. Even after adjustment for confounding factors, thrombophilia significantly raised the odds of early access occlusion (OR 3.806; 95% CI: 1.018 to 14.220; P = 0.047) 9 . aPLs are highly prevalent in ESKD.…”

Section: Introductionmentioning

confidence: 94%

“…Even after adjustment for confounding factors, thrombophilia significantly raised the odds of early access occlusion (OR 3.806; 95% CI: 1.018 to 14.220; P = 0.047). 9 aPLs are highly prevalent in ESKD. aPL includes aCLs, anti-beta-2-glycoprotein antibodies (GP), and LA.…”

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confidence: 99%

Frequent vascular access thrombosis in a patient with end stage kidney disease on hemodialysis

Kearney,

Leonberg‐Yoo,

Cohen

2023

Seminars in Dialysis

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Vascular access thrombosis (VAT) is common among patients receiving hemodialysis and leads to missed dialysis treatments, hospitalizations, catheter placement, and graft/fistula abandonment. This article reviews the association between hypercoagulability and VAT and the high prevalence of hypercoagulable states in end‐stage kidney disease (ESKD). This article reviews the role of antithrombotic and anticoagulant medications in preventing VAT. The article concludes by reviewing the unique challenges of using vitamin K antagonists in patients with ESKD.

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Thrombophilia Associated with Early Post-angioplasty Thrombosis of Dialysis Vascular Access

Abstract: Thrombophilia is associated with early occlusion after angioplasty for hemodialysis vascular access.

Cited by 6 publications

References 24 publications

Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up

Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up

Temporal distribution and biological determinants of thrombotic events after interventions for dialysis vascular access

Frequent vascular access thrombosis in a patient with end stage kidney disease on hemodialysis

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