Heparin-induced antibodies and cardiovascular risk in patients on dialysis

Lars M. Asmis; Jodi B. Segal; Laura C. Plantinga; Nancy E. Fink; Jonathan S. Kerman; Thomas S. Kickler; Josef Coresh; Lawrence B. Gardner

doi:10.1160/TH08-03-0144

Thrombosis and Haemostasis, Table of Contents

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

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

⁵Department of Internal Medicine, Division of Hematology, University Hospital of Zurich, Zurich, Switzerland

,

Jodi B. Segal

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

,

Laura C. Plantinga

²Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

³Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA

,

Nancy E. Fink

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

²Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

³Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA

,

Jonathan S. Kerman

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

³Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA

,

Thomas S. Kickler

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

,

Josef Coresh

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

²Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

³Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA

,

Lawrence B. Gardner

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

⁴Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA

› Author Affiliations

Abstract

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

Full Text

References

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