1.Anti-Heparin-Platelet Factor 4 Antibody is a Risk Factor for Vascular Access Obstruction in Patients Undergoing Hemodialysis.
Eun Young LEE ; Kyu Yoon HWANG ; Jong Oh YANG ; Sae Yong HONG
Journal of Korean Medical Science 2003;18(1):69-72
Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The prevalence of anti-heparin-platelet factor 4 antibodies was higher in hemodialysis patients than in normal subjects (8.8 vs 0.0%, p<0.05). The number of past episodes of vascular access obstruction per year was significantly higher in the anti-heparin-platelet factor 4 antibody positive group than antibody negative group. Anti-heparin-platelet factor 4 antibody positive patients experienced more frequent vascular access obstructions than control subjects. In conclusion, anti-heparin-platelet factor 4 antibody might be a risk factor for vascular access obstructions in patients with end-stage renal disease on maintenance hemodialysis.
Adult
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Autoantibodies/immunology*
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Autoimmune Diseases/immunology*
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Catheters, Indwelling*
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Enzyme-Linked Immunosorbent Assay
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Female
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Heparin/immunology*
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Human
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Kidney Failure, Chronic/blood
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Kidney Failure, Chronic/immunology
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Kidney Failure, Chronic/therapy*
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Male
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Middle Aged
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Platelet Factor 4/immunology*
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Recurrence
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Renal Dialysis*
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Risk Factors
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Thrombophilia/immunology*
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Thrombosis/epidemiology*
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Thrombosis/immunology
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Thrombosis/prevention & control
2.How Well Does the Target INR Level Maintain in Warfarin-Treated Patients with Non-ValvularAtrial Fibrillation?.
Jun Hyung KIM ; Young Bin SONG ; Dae Hee SHIN ; Je Sang KIM ; Jin Oh CHOI ; Young Kun ON ; June Soo KIM
Yonsei Medical Journal 2009;50(1):83-88
PURPOSE: Although warfarin is an effective oral anticoagulation (OAC) drug to reduce the risk of thromboembolism in patients with non-valvular atrial fibrillation (NVAF), long term follow-up data are scarce to be certain whether the target INR level is maintained in warfarin-treated patients in Korea. The aim of this study was to evaluate how well INRs are maintained within the target range using a new index, INR stability (= 100 x number of INRs within target range/total number of INR measurements) which we made, and to find out any correlation between thromboembolic events and INR stability. MATERIALS AND METHODS: This study was an observational analysis of retrospectively collected data of 129 patients with NVAF from April 2000 to December 2005 at a single tertiary hospital. All patients were registered at the anticoagulation service. RESULTS: The median duration of follow up was 2.03 years (interquartile range 1.35 - 2.96). During the follow-up period, 60.9 +/- 14.9% of the INR were within the target INR range. INR stability was not significantly different between patients without and with stroke (61.2 +/- 15.0% vs 53.3 +/- 4.9%). Among the known factors affecting fluctuations of the INR value, the most frequent factor was noncompliance (41.8%). CONCLUSION: The present study showed that it was not enough to maintain INR values within the target range in warfarin-treated patients with NVAF even at a tertiary hospital. Noncompliance is an important problem which interferes with maintaining target INR range.
Adult
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Age Factors
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Aged
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Aged, 80 and over
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Anticoagulants/*therapeutic use
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Atrial Fibrillation/*drug therapy/epidemiology/etiology
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Drug Monitoring/methods
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Female
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Follow-Up Studies
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Heart Valves
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Humans
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*International Normalized Ratio
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Male
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Middle Aged
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Patient Compliance
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Retrospective Studies
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Risk Factors
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Thrombosis/*blood/epidemiology/*prevention & control
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Warfarin/*therapeutic use