Role of Increased Factor VIII Levels in Recurrent Thrombosis of Vascular Access: A Case Report

Mahmoud Kharrat

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LETTER TO EDITOR

Year : 2006 | Volume : 17 | Issue : 1 | Page : 64-65

Role of Increased Factor VIII Levels in Recurrent Thrombosis of Vascular Access: A Case Report

Mahmoud Kharrat
Dept. of Nephrology H. Chaker hospital 3029, Sfax, Tunisia

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How to cite this article:
Kharrat M. Role of Increased Factor VIII Levels in Recurrent Thrombosis of Vascular Access: A Case Report. Saudi J Kidney Dis Transpl 2006;17:64-5

How to cite this URL:
Kharrat M. Role of Increased Factor VIII Levels in Recurrent Thrombosis of Vascular Access: A Case Report. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Jan 27];17:64-5. Available from: https://www.sjkdt.org/text.asp?2006/17/1/64/32448

To the Editor:

Vascular access site thrombosis is a major cause of morbidity in patients receiving hemodialysis. The role of hypercoagulable states in recurrent vascular access site thrombosis remains poorly understood. We herewith report a case of recurrent thrombosis of vascular access in an elderly female patient on hemodialysis.

We report on a 58-year-old female patient who was on maintenance hemodialysis (HD) thrice weekly for the previous four years. During this period, she had repetitive thrombotic complications of her vascular access resulting in necrosis of the distal fingers. The problem persisted despite warfarin sodium therapy. A detailed search for any local factors contributing to this complication did not yield any positive results. Concentrations of factors II, V, VII, VIII, X, XI, antithrombin III, protein C, protein S, anti-cardiolipin antibodies type M and G and lupus anticoagulant antibodies were investigated. The only abnormality found was high levels of factor VIII (FVIII). She died two years later due to septicemia secondary to infection of the necrosed fingers.

Similar cases have been published in literature among HD patients.[1],[2] Factor VIII is normally bound to the von Willebrand factor. Unbound Factor VIII may play a role in recurrent venous thrombosis.[3] The use of bio-incompatible dialyzers (like cuprophane) is associated with changes of Factor VIIIrelated von Willebrand concentration and significant platelet activation and loss.[4],[5] Increased levels of Factor VIII is incriminated in causing recurrent thrombosis in nondialysis patients also.[6],[7]

Hypercoagulable states are common in patients with recurrent vascular access site thrombosis. Increased factor VIII is a frequent cause in these situations, in addition to "traditional" risk factors.

References

1.	Molino D, De Santo NG, Marotta R, Anastasio P, Mosavat M, De Lucia D. Plasma levels of plasminogen activator inhibitor type 1, factor VIII, prothrombin activation fragment 1+2, anticardiolipin, and antiprothrombin antibodies are risk factors for thrombosis in hemodialysis patients. Semin Nephrol 2004; 24 (5): 495 - 501.
2.	O'shea SI, Lamson JH, Reddan D, Murphy M, Ortel TL. Hypercoagulable states and antithrombotic strategies in recurrent vascular access site thrombosis. J Vasc Surg 2003;38(3): 541-8.
3.	Schambeck CM, Grossmann R, Zonnur S, Berger M, Teuchert K, Spahn A, Walter U. High factor VIII (FVIII) levels in venous thromboembolism: role of unbound FVIII. Thromb Haemost 2004;92(1): 42-6.
4.	Schmitt GW, Moake JL, Rudy CK, Vicks SL, Hamburger RJ. Alterations in hemostatic parameters during hemodialysis with dialysers of different membrane composition and flow design. Platelet activation and factor VIII-related von Willebrand factor during hemodialysis. Am J Med 1987; 83(3):411-8.
5.	Liam F. Casserly and Laura M. Thrombosis in end-stage renal disease. Seminars in dialy 2003;16(3):245.
6.	Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 2003;125(6): 1260-7.
7.	Bowen DJ, MacLean RM, Pellard S, Collins PW. High concentrations of coagulation factor VIII and thrombosis: is the factor VIII-binding domain of von Willebrand factor implicated? Br J Haematol 2001;113(3): 655-7.

Correspondence Address:
Mahmoud Kharrat
Dept. of Nephrology H. Chaker hospital 3029, Sfax
Tunisia

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PMID: 17297541

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