PMID- 12947274
OWN - NLM
STAT- MEDLINE
DCOM- 20030925
LR  - 20190823
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 38
IP  - 3
DP  - 2003 Sep
TI  - Hypercoagulable states and antithrombotic strategies in recurrent vascular access 
      site thrombosis.
PG  - 541-8
AB  - Vascular access site thrombosis is a major cause of morbidity in patients 
      receiving hemodialysis. The role of hypercoagulable states in recurrent vascular 
      access site thrombosis remains poorly understood. Data are limited regarding 
      systemic anticoagulation to improve access graft patency, because of concern 
      about hemorrhagic complications. We determined the prevalence of hypercoagulable 
      states and clinical outcome (thrombotic and hemorrhagic) after initiation of 
      antithrombotic therapy in a series of patients with recurrent vascular access 
      site thrombosis. We evaluated 31 patients who had sustained 119 thrombotic events 
      that resulted in vascular access graft failure during the year before evaluation. 
      Sixty-eight percent of patients tested had elevated concentrations of antibody to 
      anticardiolipin or topical bovine thrombin, and 18% of patients tested had 
      heparin-induced antibodies. More than 90% of patients had elevated factor VIII 
      concentration, 62% had elevated fibrinogen concentrations, and 42% had elevated 
      C-reactive protein concentrations. Twenty-nine patients were given antithrombotic 
      therapy: 13 with warfarin sodium, 12 with unfractionated heparin (UFH), and 11 
      with low molecular weight heparin (LMWH). Seven patients received more than one 
      antithrombotic agent, sequentially. Nineteen patients have had no thrombotic 
      events since beginning antithrombotic therapy (10 with warfarin, 3 with UFH, 6 
      with LMWH). Mean follow-up was 8.6 months (median, 7 months). Eight patients 
      sustained 10 bleeding complications (5 with warfarin, 3 with UFH, and 2 with 
      LMWH). In conclusion, hypercoagulable states are common in patients with 
      recurrent vascular access site thrombosis. Antithrombotic therapy may increase 
      vascular access graft patency, but is associated with significant risk for 
      hemorrhage. Prospective studies are needed to evaluate the role and safety of 
      antithrombotic agents in improving vascular access graft patency.
FAU - O'shea, Susan I
AU  - O'shea SI
AD  - Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. 
      oshea005@mc.duke.edu
FAU - Lawson, Jeffrey H
AU  - Lawson JH
FAU - Reddan, Donal
AU  - Reddan D
FAU - Murphy, Michael
AU  - Murphy M
FAU - Ortel, Thomas L
AU  - Ortel TL
LA  - eng
GR  - K24 A10160301/PHS HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Antibodies, Anticardiolipin)
RN  - 0 (Biomarkers)
RN  - 0 (Fibrinolytic Agents)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9001-27-8 (Factor VIII)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antibodies, Anticardiolipin/analysis
MH  - Arteriovenous Shunt, Surgical/adverse effects/methods
MH  - Biomarkers/analysis
MH  - C-Reactive Protein/analysis
MH  - Catheters, Indwelling/*adverse effects
MH  - Factor VIII/analysis
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Graft Occlusion, Vascular/drug therapy/etiology
MH  - Humans
MH  - Kidney Failure, Chronic/therapy
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Recurrence
MH  - Renal Dialysis/*adverse effects/instrumentation
MH  - Risk Assessment
MH  - Thrombosis/diagnosis/drug therapy/*etiology
MH  - Treatment Outcome
MH  - Warfarin/therapeutic use
EDAT- 2003/08/30 05:00
MHDA- 2003/09/26 05:00
CRDT- 2003/08/30 05:00
PHST- 2003/08/30 05:00 [pubmed]
PHST- 2003/09/26 05:00 [medline]
PHST- 2003/08/30 05:00 [entrez]
AID - S0741521403003215 [pii]
AID - 10.1016/s0741-5214(03)00321-5 [doi]
PST - ppublish
SO  - J Vasc Surg. 2003 Sep;38(3):541-8. doi: 10.1016/s0741-5214(03)00321-5.