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Nephrol Dial Transplant (2000) 15: 1755-1760
© 2000 European Renal Association-European Dialysis and Transplant Association

Invited Comment

Coagulation and haemodialysis access thrombosis

Johannes H. M. Smits1,, Joke van der Linden2, Peter J. Blankestijn1 and Ton J. Rabelink3

1 Department of Nephrology, University Medical Center, Utrecht, 2 Department of Internal Medicine, Medisch Centrum Rijnmond-Zuid, location Clara, Rotterdam and 3 Department of Internal Medicine, University Medical Center, Utrecht,The Netherlands

Introduction

An increased thrombotic tendency is an important cause of complications in chronic haemodialysis patients, leading not only to possibly fatal complications like ischaemic heart disease or stroke, but also to thrombosis of the vascular access [1]. This latter complication remains the main problem in vascular access for haemodialysis, particularly in polytetrafluoroethylene (PTFE) grafts. It accounts for considerable morbidity and mortality with an estimated annual cost of close to $1 billion in the United States. Moreover, vascular access complications mainly consisting of thrombotic events are responsible for 17–25% of all hospitalizations in dialysis patients [2–4].

In most cases thrombosis is associated with low access blood flow [5–7]. The most important reason for a decreasing access blood flow is intimal hyperplasia formation at the venous anastomosis or in the outflow tract of the graft [8–13]. However, not all . . . [Full Text of this Article]

Normal haemostasis and fibrinolysis

Factors in chronic haemodialysis patients contributing to thrombotic tendency

Platelet abnormalities

Plasma factor abnormalities

Therapeutic considerations

Antiplatelet therapy
Oral anticoagulation
Conclusion

Acknowledgments

Notes

References


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