Effectiveness of and risk associated with aspirin therapy in hemodialysis patients with a background of antiplatelet factor 4/heparin complex antibody detection.
BACKGROUND
The optimal prevention measures against hemodialysis (HD)-associated complications, including all-cause thrombotic events and death, are unclear.


METHODS
This prospective study was designed to assess the effect of aspirin on prevention of HD-associated complications. Patients were divided into four groups according to platelet factor-4/heparin-complex (PF4/H) antibody detection and aspirin prescription: Group 1, antibody(-)/aspirin(+); Group 2, antibody(-)/aspirin(-); Group 3, antibody(+)/aspirin(+); and Group 4, antibody(+)/aspirin(-). Adverse events were compared among all four groups. Cox hazard regression was performed to analyze the effects of anti-PF4/H antibody and aspirin on thrombosis and death.


RESULTS
This study included 648 patients undergoing HD; 142 were positive for anti-PF4/H antibodies, and 229 had received aspirin before enrollment. During the 4-year follow-up period, 138 patients developed thrombosis, and 63 of these events were anti-PF4/H antibody-associated. A total of 112 patients died; 75 died of coronary heart disease (CHD). Group 4 had a significantly higher incidence of total and anti-PF4/H antibody-associated thrombosis events as well as total and CHD-associated death than did the other three groups. Aspirin had a preventive effect against all adverse events in anti-PF4/H antibody-positive patients, but not in antibody-negative patients. Group 1 patients with baseline D-dimer levels of <0.6μg/mL developed more hemorrhagic events than did patients in the other groups.


CONCLUSIONS
Aspirin prevention of thrombosis and death in patients undergoing HD might require consideration of the anti-PF4/H antibody status. In antibody-positive individuals, taking aspirin could improve the prognosis and therefore might be recommended. In antibody-negative individuals, prevention was minimal and the bleeding risk was obviously increased; thus, aspirin should be avoided or at least require careful evaluation prior to aspirin treatment.
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Yang
Y
Yang
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Chao
C
Wang
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Liping
L
Jin
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Guanglei
G
Chen
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Changchun
C
Li
Hemodialysis Centre, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Ka
K
Qi
Hemodialysis Centre, First Affiliated Hospital of Haerbin Medical University, Haerbin, China.
Deyang
D
Kong
Hemodialysis Centre, General Hospital of Beijing Military Region, Beijing, China.
Yaping
Y
Wang
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China.
Minghui
M
Song
Kidney Therapeutic Center of Traditional Chinese and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, Qinhuangdao, China. Electronic address: malu281@163.com.
Lu
L
Ma
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D001241:Aspirin / Q000627:therapeutic use*; D003327:Coronary Disease / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010978:Platelet Factor 4 / Q000276:immunology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*
D000906:Antibodies; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D010978:Platelet Factor 4; D006493:Heparin; D001241:Aspirin
antiplatelet; death; hemodialysis; platelet factor 4; thrombosis