Venous thromboembolism and vascular access thrombosis in patients with end-stage renal disease on chronic hemodialysis: results of the VIVALDI study

O. Königsbrügge, E. Grilz, I. Pabinger, M. Säemann, C. Ay (Vienna, Austria)

Acquired problems and alterations of coagulation
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: Venous thromboembolism (VTE) and vascular access thrombosis are common complications in hemodialysis (HD) patients. We aimed at investigating the burden of thromboembolic events and antithrombotic practice patterns in a cross-sectional analysis of HD patients.

Methods: The Vienna InVestigation of AtriaL fibrillation and thromboembolism in HeModialysiS patients (VIVALDI) is a population-based cohort study to investigate the risk of stroke, venous thromboembolism, bleeding and mortality in HD patients from 7 major dialysis centers, recruited in 2014-2015. At baseline, detailed patient histories were taken and verified with medical records at the HD centers. A history VTE including deep vein thrombosis [DVT] and pulmonary embolism [PE], was differentiated from vascular access thrombosis, including shunt thrombosis and catheter-associated thrombosis.

Results: We recruited 626 patients on maintenance HD (median age 66 years, 37 % women). A history of VTE was found in 61 (9.7%) patients (32 PE [5.1%], 44 DVT [7.0%]) and a history of access thrombosis in 178 patients (28.4%), 146 patients with shunt thrombosis and 38 patients with catheter-associated thrombosis. In multivariable age-adjusted logistic regression, VTE was independently associated with atrial fibrillation (AF) (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.2–7.5) and time on hemodialysis treatment (OR 1.1 per 1 year increase, CI 1.0–1.2). A history of access thrombosis was only associated with time on hemodialysis (OR 1.2, CI 1.1–1.2) in a multivariable logistic regression model, but not with a history of VTE. Fifty-five patients (30.9%) with access thrombosis were receiving long-term anticoagulation at the time of recruitment. In 27 cases low-molecular-weight heparins s.c. on non-HD days and in 28 cases oral anticoagulation with vitamin-K-antagonists was the treatment of choice. Patients with a history of access thrombosis were more likely to receive long-term anticoagulation treatment if they had AF (OR 3.2, CI 1.5-6.9), a history of stroke (OR 2.4, CI 1.1-5.5), or a history of VTE (OR 5.8, CI 2.1-15.9).

Conclusion: Histories of VTE and access thrombosis were frequent in hemodialysis patients. Patients were more likely to receive long-term anticoagulation when further risk factors for thromboembolic events, such as a history of VTE, stroke or AF were present, indicating the need for hemodialysis-specific risk evaluation.