[Relation between the blood coagulation status in hemodialyzed patients and arteriovenous fistula thrombosis--prospective study]. / Vztah mezi hemokoagulacním stavem hemodialyzovaných pacientu a trombózami arteriovenózní pístele--prospektivní studie.

BACKGROUND: In a number of haemodialyzed patients occlusion of arteriovenous fistulae for different reasons occurs. In these patients many haemocoagulation changes are described. The objective of the present work was to assess whether these occlusions are due to hypercoagulation. METHODS AND RESULTS: The investigation comprised 49 men and 32 women aged 49.3 +/- 9.3 years with renal insufficiency which had persisted for 28 +/- 17 months. Before the fistula was made, some parameters of haemocoagulation were examined. Depending whether within 6 months occlusion of the fistula occurred, the patients were divided into two groups. In a group of 18 patients with thrombosis of the fistula euglobulin fibrinolysis without stimulus (340 +/- 48 min.) was longer, also after veno-occlusion (199 +/- 50 min.), as compared with the group without thrombosis (277 +/- 38 and 121 +/- 27 min. resp.) and the level of the inhibitor of the plasminogen activator (PAI-1) differed: 3.3 +/- 0.6 i.u. as compared with 2.6 +/- 0.8 i.u. P < 0.001 in all three parameters. In the other parameters no significant differences were found (haematocrit, fibrinogen, F VII, AT III, protein C, number and aggregation of thrombocytes) al in all instances P > 0.05. The sum of hypercoagulation findings was higher in the first group (5.3 +/- 1.5) than in the second group (3.5 +/- 1.5, P < 0.001). CONCLUSIONS: The authors assume that apart from other factors thrombosis of the fistula is influenced also by the haemocoagulation status, in particular fibrinolytic parameters. The latter may be supported also by other hypercoagulation factors which alone are ineffective.