Brunet P, Aillaud M-F, San Marco M, Philip-Joet C, Dussol B,
Bernard D, Juhan-Vague I, Berland Y
Antiphospholipids in hemodialysis patients: Relationship
between lupus anticoagulant and thrombosis
Kidney Int
(Sep) 48:794-800 1995
Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are acquired
antiphospholipid
antibodies (APL) which appear to be present in an elevated proportion of HD
patients and which may
be associated with thrombotic complications. Brunet et al measured APL
antibody levels in 97 HD
patients, and found an APL prevalence of 31%, split evenly between LA
(detected by the TTI method)
and ACA. Contrary to reports by others, there was no association between APL
positivity and use of
Cuprophan membranes. Retrospectively, increased LA, but not ACA, was
associated with an increased
occurrence of graft thrombosis (+LA, graft thrombosis risk 62%; -LA, risk
37%). Interestingly,
presence of either LA or ACA was not associated with increased mortality,
although most patients
with +LA were receiving coumadin. Two years later, measurements were
repeated in 8 patients
previously positive for ACA and 8 for LA. All of the ACA patients were now
negative, whereas 7/11
LA patients remained positive. Despite their findings, the authors do not
recommend screening HD
patients for LA, nor do they recommend placing all patients who are LA
positive on anticoagulation.
(Daugirdas)
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Basic hemodialysis :
Vascular Access: graft/fistula
CRF by problem area :
Anemia/Erythropoietin/Iron