Is Heparin-Induced Platelet Activation an Unrecognized Cause of Thrombosis in Chronic Dialysis Patients?

Abstract

Despite an increase in vaso-occlusive disorders and routine exposures to large quantities of heparin, chronic dialysis (CD) patients have not been studied for the presence of heparin-induced platelet activation (HIPA). Measurement of platelet aggregation and adenosine triphosphate release was performed at hepa rin concentrations of 0.1 U/mL and 100 U/mL using platelet-poor plasma (PPP) from 90 nonthrombocytopenic CD patients; 72 patients received heparin over prolonged periods (108 ±15 weeks); 18 patients received no heparin for two months prior to study.

Results: PPP from 1 hemodialysis (HD) patient stimulated strong ( > 19%) platelet activation at both 0.1 and 100 U/mL heparin concentrations. Four pa tients (4.4%) demonstrated intermediate (10-19%) platelet activation in the presence of 0.1 U/mL but not 100 U/mL heparin concentrations. Eighty-five patients demonstrated no platelet activation ( < 10%) at either heparin concen tration.

Conclusion: (1) None of the 90 dialysis patients met the strict laboratory criteria for HIPA. (2) Despite long-term exposure to large quantities of heparin, the prevalence of HIPA in CD patients appears to be no greater than that of the general patient population receiving heparin. (3) Nonthrombocytopenic HIPA is not a major factor contributing to thrombotic disorders in dialysis patients.

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