International Urology and Nephrology

, Volume 50, Issue 12, pp 2289–2297 | Cite as

Significant association of anti-platelet factor 4/heparin antibody with cardiovascular disease in hemodialysis patients: a longitudinal 7-year study

  • Chi-Chu Liu
  • Li-Ping Chou
  • Tsang-Shan Chen
  • Chien-An ChenEmail author
  • Yueh-Feng Tsai
Nephrology - Original Paper



Hemodialysis patients have a high incidence of anti-platelet factor 4/heparin antibody (PF4-H Ab) and are at a high risk of cardiovascular disease. This study determines the association between PF4-H Ab and cardiovascular events including coronary artery disease (CAD), ischemic stroke (IS), and native arteriovenous fistula thrombosis (AVFT), in a longitudinal 7-year follow-up.

Patients and methods

84 hemodialysis patients were enrolled. Data collection included chart reviews and assessments of laboratory records. PF4-H Ab was evaluated by ELISA and a titer ≥ 0.4 was defined to have PF4-H Ab.


30 patients were PF4-H Ab positive, 30 patients had CAD, 29 patients had IS, and 43 patients had AVFT. In Cox proportional hazard regression analysis, PF4-H Ab (HR 2.72, p = 0.01) was a significant risk factor for CAD. Age (HR 1.06, p = 0.003), PF4-H Ab (HR 4.53, p < 0.001), 7-year averaged serum phosphate levels (HR 0.53, p = 0.012), and 7-year averaged blood platelet count (HR 1.01, p = 0.029) were risk factors for IS. Age (HR 1.03, p = 0.047), PF4-H Ab (HR 3.57, p < 0.001), and 7-year averaged serum triglyceride levels (HR 1.01, p = 0.005) were risk factors for AVFT. In PF4-H Ab-positive groups, thrombocytopenia was not associated with CAD, IS, and AVFT by Fisher’s test analysis.


This study reveals that PF4-H Ab is a risk factor for developing CAD, IS, and AVFT among hemodialysis patients.


Arteriovenous fistula thrombosis Anti-PF4/heparin antibody Coronary artery disease Ischemic stroke 



The work was supported by the Nephrology Laboratory, Kaohsiung Medical University, Kaohsiung, Taiwan. The authors acknowledge Eric Kim-Tai Lui (Faculty of Biochemistry, University of Toronto, Scarborough, Ontario, Canada) for excellent assistances.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by Institutional Ethics Committee of Tainan Sinlau Hospital.

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of AnesthesiaTainan Sinlau HospitalTainanTaiwan
  2. 2.Department of Health Care AdministrationChang Jung Christian UniversityTainanTaiwan
  3. 3.Department of CardiologyTainan Sinlau HospitalTainanTaiwan
  4. 4.Department of NeurologyTainan Sinlau HospitalTainanTaiwan
  5. 5.Department of NephrologyTainan Sinlau HospitalTainanTaiwan

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