title: In uremia, plasma levels of anti-protein C and anti-protein S antibodies are associated with thrombosis.
abstract: BACKGROUND
  Vascular access thrombosis is an important cause of morbidity in patients with end-stage renal failure on maintenance hemodialysis (MHD). However, little is known about its risk factors. The present study was undertaken to evaluate the role of coagulation factors, fibrinolytic factors, and anti-phospholipid antibodies (aPL). In particular, we have evaluated the role of anti-protein C and anti-protein S antibodies in patients on MHD with and without thrombosis because no data are available in the literature.
  
  
  METHODS
  The study group comprised 30 patients with thrombotic complications (TC), 40 patients matched for age, sex, and dialytic age with no thrombotic complications (NTC) and 400 controls. We have measured: anti-protein C antibodies, anti-protein S antibodies, anticardiolipin antibodies (ACA), anti-beta2-glycoprotein antibodies (beta2-GPI), and anti-prothrombin antibodies (aPT), along with prothrombin time, fibrinogen, plasminogen, protein C, protein S, anti-thrombin III, APC-resistance test, D-dimer, tissue-type plasminogen's activator, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1+2, factors of the intrinsic and extrinsic pathway, C-reactive protein, and homocysteine.
  
  
  RESULTS
  There were no significant differences between groups for prothrombin time, fibrinogen, plasminogen, protein C, protein S, anti-thrombin III, activated protein C (APC) resistance, D-dimer, tPA, C-reactive protein, Factors II, X, and VII. The anti-beta2-GP1 and aPT were elevated in both TC and NTC patients, compared to the control group. Significant differences between TC and NTC groups were found for anti-protein C and anti-protein S antibodies, ACA-IgM, PAI-1, Factor VIII, prothrombin fragments 1+2, and homocysteine.
  
  
  CONCLUSIONS
  The most novel finding was a significant elevation of anti-protein C antibodies and anti-protein S antibodies in the TC group (i.e., in patients on MHD with thrombosis of vascular access). It indicates that other pathogenetic mechanisms in addition to endothelial damage may cause hypercoagulability in uremia.
authors.affiliation: First Division of Nephrology, Second University of Naples, Naples, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molino
authors.forename: Domenico
authors.initials: D
authors.lastname: De Lucia
authors.forename: Rosa
authors.initials: R
authors.lastname: Marotta
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perna
authors.forename: Cinzia
authors.initials: C
authors.lastname: Lombardi
authors.forename: Massimo
authors.initials: M
authors.lastname: Cirillo
authors.forename: Natale Gaspare
authors.initials: NG
authors.lastname: De Santo
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000097:blood*; D004730:Endothelium, Vascular / Q000276:immunology; D005260:Female; D006487:Hemostasis / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000276:immunology*; D017293:Protein S / Q000276:immunology*; D016036:Seroepidemiologic Studies; D013927:Thrombosis / Q000453:epidemiology / Q000276:immunology*; D014511:Uremia / Q000453:epidemiology / Q000276:immunology*
chemical_list: D017152:Antibodies, Antiphospholipid; D011486:Protein C; D017293:Protein S