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Thromb Haemost 2008; 100(03): 498-504
DOI: 10.1160/TH08-03-0144
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Heparin-induced antibodies and cardiovascular risk in patients on dialysis

Lars M. Asmis
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
5   Department of Internal Medicine, Division of Hematology, University Hospital of Zurich, Zurich, Switzerland
,
Jodi B. Segal
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
,
Laura C. Plantinga
2   Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
3   Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
,
Nancy E. Fink
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2   Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
3   Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
,
Jonathan S. Kerman
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
3   Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
,
Thomas S. Kickler
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
,
Josef Coresh
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2   Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
3   Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
,
Lawrence B. Gardner
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
4   Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA
› Author AffiliationsFinancial support: Supported in part by the General Clinical Research Center (NIH/NCRR grant M01-RR000052) at the Johns Hopkins University School of Medicine and an investigator initiated research grant by Glaxo Smith Kline Corporation. The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study was supported by RO1-HL-62985 (National Heart, Lung, and Blood Institute [NHLBI]) and RO1-DK-59616 (National Institute of Diabetes & Digestive & Kidney Diseases [NIDDK]). Dr Asmis was supported by the Swiss Foundation for Medical-Biological Grants (grant 1087) and an investigator-initiated research grant awarded by Glaxo Smith Kline Corporation to Johns Hopkins University School of Medicine. Dr Coresh is supported in part as an American HeartAssociation established investigator (01–4019–7N). The study was designed, conducted, analysed, and submitted for publication independently of the sponsors.
Further Information

Publication History

Received 07 March 2008

Accepted after major revision 20 June 2008

Publication Date:
22 November 2017 (online)

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Summary

The clinical relevance of heparin-induced antibodies (HIA) in the absence of thrombocytopenia remains to be defined. The aims of this study were (i) to determine the prevalence of HIA in patients treated by dialysis, (ii) to determine the prevalence of thrombocytopenia and heparin-induced thrombocytopenia (HIT), and (iii) to test whether HIA are associated with adverse outcomes. Sera from 740 patients treated by hemodialysis (HD, n=596) and peritoneal dialysis (PD, n=144) were tested for HIA (IgG, IgA or IgM) by masked investigators at approximately six months after enrolment in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. We assessed, with time-to-event Cox proportional hazards models, whether the presence of HIA predicted any of four clinical outcomes: arterial cardiovascular events, venous thromboembolism, vascular access occlusion and mortality. HIA prevalence was 10.3% overall. HIA positivity did not predict development of thrombocytopenia or any of the four clinical outcomes over a mean follow-up of 3.6 years, with hazard ratios for arterial cardiovascular events of 0.98 (95% confidence interval 0.70–1.37), venous thromboembolism 1.39 (0.17–11.5), vascular access occlusion 0.82 (0.40–1.71), and mortality 1.18 (0.85–1.64). Chronic intermittent heparin exposure was associated with a high seroprevalence of HIA. In dialysis patients these antibodies were not an independent risk factor for cardiovascular events and mortality. Our data do not suggest that dialysis patients should be monitored for HIA antibodies in the absence of thrombocytopenia.

Keywords

Cardiovascular risk - dialysis - heparin-induced antibodies - survival analysis - thrombocytopenia
 

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