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https://www.um.edu.mt/library/oar/handle/123456789/103786
Title: | Prothrombotic changes in platelet, endothelial and coagulation function following hemodialysis |
Authors: | Milburn, James A. Cassar, Kevin Ford, Isobel Fluck, Nicholas Brittenden, Julie |
Keywords: | Hemodialysis -- Patients Heparin -- Side effects Blood platelets -- Activation Blood-vessels -- Diseases -- Patients Blood coagulation factors Heparin -- Therapeutic use Atherosclerosis Thrombosis |
Issue Date: | 2011 |
Publisher: | Sage Publications Ltd. |
Citation: | Milburn, J. A., Cassar, K., Ford, I., Fluck, N., & Brittenden, J. (2011). Prothrombotic changes in platelet, endothelial and coagulation function following hemodialysis. The International Journal of Artificial Organs, 34(3), 280-287. |
Abstract: | Purpose: Patients on hemodialysis (HD) have an increased risk of thrombotic events, including myocardial infarction and vascular access thrombosis. The study hypothesis is that a single session of dialysis leads to platelet, endothelial & coagulation activation. Our aim is to determine the effect of a single HD session on prothrombotic vascular biomarkers before and after a single session of hemodialysis. Methods: Blood samples were taken from the vascular access of 55 patients immediately before and after a hemodialysis session. Platelet function was assessed by (1) flow cytometric measurement of P-selectin expression and fibrinogen binding ± ADP stimulation, (2) Ultegra rapid platelet function assay (RPFA) using the agonists thrombin receptor activating peptide (TRAP) and arachidonic acid (AA), (3) soluble P-selectin, and (4) soluble CD40L. Coagulation (thrombin-antithrombin III [TAT] and D-dimer), endothelial von Willebrand factor (vWF) and high sensitivity C-Reactive protein (hsCRP) were assessed by ELISA. Results: Unfractionated heparin was given to all patients during dialysis and 30 patients (55%) were on antiplatelet agents. Post-hemodialysis there were significant increases in unstimulated platelet P-selectin (p=.037), stimulated P-selectin (p<.001), soluble P-selectin (p<.001) and soluble CD40L (p=.036). Stimulated platelet fibrinogen binding was increased post-hemodialysis (p<.001) but unstimulated fibrinogen binding was unchanged. TRAP- (p<.001) and AA-(p=.009) stimulated aggregation were reduced post-hemodialysis. There were increases post-hemodialysis in TAT (p<.001), D-dimer (p<.001), vWF (p<.001) and hsCRP (p=.011). Conclusion: This study has shown that despite heparin therapy, a single session of HD induced in- creases in platelet, endothelial, and coagulation activation. More effective medical strategies to reduce the prothrombotic state of patients on hemodialysis should be investigated. |
URI: | https://www.um.edu.mt/library/oar/handle/123456789/103786 |
ISSN: | 03913988 |
Appears in Collections: | Scholarly Works - FacM&SSur |
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File | Description | Size | Format | |
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Prothrombotic_changes_in_platelet,_endothelial_and_coagulation_function_following_hemodialysis(2011).pdf Restricted Access | 85.44 kB | Adobe PDF | View/Open Request a copy |
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