Antibodies to topical bovine thrombin correlate with access thrombosis

Bovine thrombin is often used topically to promote hemostasis during vascul ar surgery, including dialysis-access placement. Patients frequently develo p antibodies to bovine thrombin preparations, and some may develop antiphos pholipid antibodies. We evaluated 88 hemodialysis patients for the presence of antibodies to topical bovine thrombin to determine if elevated antibody levels correlated with vascular access thrombosis. Twenty-seven patients ( 30.7%) had elevated antibody levels to topical bovine thrombin. More patien ts with elevated antibody levels had prior vascular access thrombosis than patients with normal antibody levels (13 of 27 versus 5 of 61 patients; P < 0.001). This difference was almost entirely the result of greater levels o f thrombosis in patients with polytetrafluoroethylene (PTFE) grafts and ele vated antibody levels. In these patients, 11 of 13 patients (84.6%) with el evated antibody levels had a previous thrombosis compared with 2 of 15 pati ents (13.3%) with normal antibody levels (P < 0.001). Patients with elevate d antibody levels and PTFE grafts also had more prior thromboses (1.92 +/- 1.60 versus 0.133 +/- 0.35 thromboses; P < 0.01) and a greater thrombosis r ate (66.89 +/- 63.71 versus 4.65 +/- 12.05 thromboses/100 patient-years; P < 0.01) than patients with normal antibody levels. There were no difference s in the frequency of myocardial infarction, coronary artery bypass, access age, presence of diabetes mellitus, platelet counts, anticardiolipin antib ody, albumin, lactate dehydrogenase, or C-reactive protein levels. In concl usion, patients with PTFE grafts and elevated antibody levels to topical bo vine thrombin had significantly more vascular access thrombosis. (C) 2000 b y the National Kidney Foundation, Inc.