Thrombogenesis and Anticoagulation in Patients Undergoing Chronic Hemodialysis

  • Gianluigi Viganò
  • Arrigo Schieppati
  • Giuseppe Remuzzi


A tendency toward thrombosis (particularly of the arterovenous shunt) is a frequent complication of uremic patients on hemodialysis. It is well known that uremia is associated with complex coagulation abnormalities (1, 2, 3, 4) which include both bleeding diathesis (for a review see chapter by Winchester JF) and hypercoagulability. Table 1 shows the factors involved in the latter disturbance. The results of the global coagulation screening tests in uremic patients are generally normal. Most consistent findings are an increased level of fibrinogen (5) and decreased protein C anticoagulant activity with normal amidolytic activity and antigen (6, 7). Recently, it has been documented that the reduced protein C anticoagulant activity is due to the presence of a soluble plasma inhibitor that interferes specifically with the anticoagulant activity of activated protein C (8). Given the role of fibrinogen and protein C in coagulation homeostasis, it is not surprising that these abnormalities contribute to the increased risk of thrombosis episodes in these patients. In vivo studies have also demonstrated enhanced platelet activity in this population (9, 10, 11).


Vascular Access Anticoagulant Activity Dermatan Sulphate Uremic Patient Extracorporeal Circuit 
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Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Gianluigi Viganò
    • 1
  • Arrigo Schieppati
    • 1
  • Giuseppe Remuzzi
    • 2
  1. 1.Clinical Res.Cntr. for Rare Diseases ‘Aldo e Cele Daccb’Mario Negri Inst. for Pharmacol. Res.RanicaItaly
  2. 2.Division of Nephrology and DialysisOspedali Riuniti di BergamoBergamoItaly

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