Document Detail

Association of heparin-dependent antibodies and adverse outcomes in hemodialysis patients: a population-based study.
MedLine Citation:
PMID:  16092577     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether some adverse outcomes of hemodialysis could be explained by subclinical heparin-induced thrombocytopenia (HIT).
PATIENTS AND METHODS: Platelet factor 4 (PF4)-heparin antibodies were measured by enzyme-linked immunosorbent assay In a population-based cohort of hemodlalysis patients. Participants were then followed up prospectively for thromboembollc events, cardiovascular events, or death.
RESULTS: Of the 59 hemodialysis patients residing In Olmsted County, Minnesota, 57 (97%) agreed to study participation. The mean +/- SD age of the patients was 64 +/- 17 years (median hemodialysis duration, 23 months), and 27 (47%) were women. The enzyme-linked Immunosorbent assay was positive for PF4-heparin antibodies in 2 patients (3.5%). The PF4-heparin antibody content varied over a 10-fold range and was not associated with the duration of hemodialysis (P = .99). During a median follow-up of 798 days, 16 thrombotic events, 37 cardiovascular events, and 23 deaths (Including 13 cardiovascular deaths) occurred. After adjusting for the Framingham risk score, the all-cause mortality rate was significantly higher for patients with the highest tertile of PF4-heparln antibody content compared with patients in the lower tertilles (hazard ratio, 2.47; P = .03). Furthermore, 8 (73%) of deaths in this tertile were due to cardiovascular causes (hazard ratio, 4.14; P = .02).
CONCLUSIONS: Despite repetitive heparin exposure, the prevalence of HIT In patients undergoing maintenance hemodialysis is no greater than that anticipated for other patient populations. However, to our knowledge, this is the first study to show an association between elevated PF4-heparin antibodies and Increased mortality rates in hemodlalysis patients.
Lourdes Pena de la Vega; Randal S Miller; Margaret M Benda; Diane E Grill; Matthew G Johnson; James T McCarthy; Robert D McBane
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  80     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-11     Completed Date:  2005-08-23     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  995-1000     Citation Subset:  AIM; IM    
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MeSH Terms
Antibodies / isolation & purification*
Anticoagulants / adverse effects*,  therapeutic use
Cardiovascular Diseases / mortality
Confidence Intervals
Enzyme-Linked Immunosorbent Assay
Heparin / adverse effects*,  therapeutic use
Kidney Failure, Chronic / therapy
Middle Aged
Platelet Factor 4 / immunology*
Prospective Studies
Renal Dialysis / adverse effects*
Thrombocytopenia / chemically induced*,  diagnosis
Reg. No./Substance:
0/Antibodies; 0/Anticoagulants; 37270-94-3/Platelet Factor 4; 9005-49-6/Heparin
Comment In:
Mayo Clin Proc. 2006 Feb;81(2):263; author reply 263   [PMID:  16471084 ]
Mayo Clin Proc. 2005 Aug;80(8):988-90   [PMID:  16092575 ]

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