Inhibition of platelet activation could decrease thrombotic events in hemodialysis PF4/H antibody-positive patients

Abstract

Background: Platelet factor 4/heparin (PF4/H) antibody detection is widely used to evaluate the risk of thrombosis in patients undergoing hemodialysis (HD). Most patients who are PF4/H-antibody-positive can survive thrombosis, but the reason has not been clarified. In addition, no valid preventive methods for thrombosis in patients undergoing HD have been confirmed. Methods: A single-center, semi-randomized controlled study was designed. In total, 157 patients fulfilled the inclusion criteria and participated. Patients were first divided according to PF4/H antibody detection and then subdivided randomly according to different anti-platelet agent descriptions. Results: (1) PF4/H antibody-positive patients suffered a significantly higher incidence of thrombosis than those who were antibody-negative; (2) PF4/H antibody-positive patients who survived a thrombosis manifested a significantly longer bleeding time and decreased maximum percentage of platelet aggregation inhibition; (3) aspirin and clopidogrel decreased the incidence of thrombosis in PF4/H antibody-positive patients by inhibiting platelet activation. Conclusion: The PF4/H antibody was effective for prediction of the risk of thrombosis, except in patients with dysfunctional platelets; aspirin manifested effects similar to clopidogrel in terms of prevention of thromboses in PF4/H antibody-positive patients, but costs much less and is therefore recommended.

• Anti-platelet
• heparin-induced thrombocytopenia
• PF4/H antibodies
• platelet dysfunction
• thrombosis

Acknowledgments

The authors thank Deyang Kong, PhD and Lirong Hao, PhD of the First Affiliated Hospital of Harbin Medical University for help with the study design and data analysis. Some important analytical equipment used in this study was graciously provided by the First Affiliated Hospital of Harbin Medical University.