The impact of activated protein C resistance on the patency of arteriovenous grafts for hemodialysis access

Semin Dial. 2022 Jan;35(1):58-65. doi: 10.1111/sdi.13042. Epub 2021 Dec 9.

Abstract

Introduction: Vascular access is required for hemodialysis treatment. An effect of activated protein C resistance on access thrombosis rates has not yet been investigated. The aim of this study is to determine whether an activated protein C resistance is correlated with the patency of polytetrafluoroethylene arteriovenous grafts.

Methods: The primary endpoint was the impact of activated protein C resistance; secondary endpoints were the influence of Factor V Leiden thrombophilia, homocysteine, ß2-glycoprotein antibodies, and other laboratory values on the assisted primary patency.

Results: Forty-three grafts in 43 patients were included. The overall mean assisted primary patency was 18.4 months (±3.16 SE). Activated protein C resistance (p = 0.01) and ß2-glycoprotein antibodies (p = 0.018) had a significant influence on the assisted primary patency. The assisted primary patency for patients with low (<4) activated protein C resistance was 9.3 months compared to 24.8 of those with a high (≥4) activated protein C resistance. Patients with low (≤2.6) ß2-glycoprotein antibodies presented an assisted primary patency of 31.8 months whereas those with high (>2.6) ß2-glycoprotein antibodies showed 9.3 months. In all patients with a pathologic activated protein C resistance, a heterozygous or homozygous Factor V Leiden thrombophilia was detected.

Conclusions: This study identified low activated protein C resistance and high ß2-glycoprotein antibodies as risk factors for thrombosis in polytetrafluoroethylene arteriovenous grafts. A prospective study is needed to clarify if oral anticoagulation should be administered to all patients with a pathologic activated protein C resistance blood value and/or factor V Leiden mutation.

MeSH terms

  • Activated Protein C Resistance* / complications
  • Arteriovenous Shunt, Surgical* / adverse effects
  • Blood Vessel Prosthesis / adverse effects
  • Graft Occlusion, Vascular / etiology
  • Humans
  • Polytetrafluoroethylene
  • Renal Dialysis / adverse effects
  • Thrombophilia
  • Thrombosis* / etiology
  • Thrombosis* / prevention & control
  • Treatment Outcome
  • Vascular Patency

Substances

  • Polytetrafluoroethylene

Supplementary concepts

  • Thrombophilia due to Activated Protein C Resistance
  • Thrombophilia, hereditary