title: Thrombin-anti-thrombin levels and patency of arterio-venous fistula in patients undergoing haemodialysis compared to healthy volunteers: a prospective analysis.
abstract: BACKGROUND
  Patients on haemodialysis (HD) are at an increased risk of sustaining thrombotic events especially to their vascular access which is essential for maintenance of HD.
  
  
  OBJECTIVE
  To assess whether 1) markers of coagulation, fibrinolysis or endothelial activation are increased in patients on HD compared to controls and 2) if measurement of any of these factors could help to identify patients at increased risk of arteriovenous (AVF) access occlusion.
  
  
  METHODS
  Venous blood samples were taken from 70 patients immediately before a session of HD and from 78 resting healthy volunteers. Thrombin-antithrombin (TAT), D-dimer, von Willebrand factor (vWF), plasminogen activator inhibitor-1 antigen (PAI-1) and soluble p-selectin were measured by ELISA. C-reactive protein (hsCRP) was measured by an immunonephelometric kinetic assay. Determination of the patency of the AVF was based upon international standards and was prospectively followed up for a minimum of four years or until the AVF was non-functioning.
  
  
  RESULTS
  A total of 70 patients were studied with a median follow-up of 740 days (range 72-1788 days). TAT, D-dimer, vWF, p-selectin and hsCRP were elevated in patients on HD compared with controls. At one year follow-up, primary patency was 66% (46 patients). In multivariate analysis TAT was inversely associated with primary assisted patency (r = -0.250, p = 0.044) and secondary patency (r = -0.267, p= 0.031).
  
  
  CONCLUSIONS
  The novel finding of this study is that in patients on haemodialysis, TAT levels were increased and inversely correlated with primary assisted patency and secondary patency. Further evaluation is required into the possible role of TAT as a biomarker of AVF occlusion.
authors.affiliation: Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland. j.milburn@nhs.net
authors.forename: James A
authors.initials: JA
authors.lastname: Milburn
authors.forename: Isobel
authors.initials: I
authors.lastname: Ford
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Mutch
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fluck
authors.forename: Julie
authors.initials: J
authors.lastname: Brittenden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058833:Antithrombin Proteins / Q000378:metabolism*; D001164:Arteriovenous Fistula / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019007:P-Selectin / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D013917:Thrombin / Q000378:metabolism*; D013997:Time Factors; D014654:Vascular Patency; D055815:Young Adult; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D058833:Antithrombin Proteins; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D019007:P-Selectin; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D014841:von Willebrand Factor; D002097:C-Reactive Protein; D013917:Thrombin