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Thromb Haemost
DOI: 10.1055/a-2700-6368
Stroke, Systemic or Venous Thromboembolism

Venous Thromboembolism and Vascular Access Thrombosis in Patients on Hemodialysis: Incidence, Risk Factors, and Use of Antithrombotic Agents

Authors

  • Oliver Königsbrügge

    1   Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
    2   Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan

  • Renate Klauser-Braun

    3   Department of Medicine III, Clinic Donaustadt, Vienna, Austria

  • Sabine Schmaldienst

    4   Department of Medicine I, Clinic Favoriten, Vienna, Austria

  • Matthias Lorenz

    5   Vienna Dialysis Center, Vienna, Austria

  • Ingrid Pabinger

    1   Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria

  • Marcus Säemann

    6   Department of Medicine VI, Clinic Ottakring, Vienna, Austria

  • Cihan Ay

    1   Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria

Funding Information The VIVALDI study was supported by an unrestricted grant from the Austrian National Bank (Jubiläumsfond Österreichische Nationalbank, Project Number 16433), Joseph-Skoda-Prize of the Austrian Association of Internal Medicine (ÖGIM), and the Austrian Science Fund (FWF), Special Research Program (SFB) 54.
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Abstract

Background

Patients with end-stage kidney disease on hemodialysis (HD) have an increased risk of venous thromboembolism (VTE) and HD-specific vascular access thrombosis (VAT). We aimed to capture the incidence of VTE and VAT events and investigate risk factors for VTE and VAT occurrence, including antithrombotic agent use.

Methods

Prevalent patients on maintenance HD were recruited into a prospective, population-based, observational cohort study in Vienna, Austria. During a maximum follow-up of 45 months, the occurrence of VTE, defined as deep vein thrombosis, catheter- or noncatheter-associated, and pulmonary embolism, or VAT, defined as thrombotic occlusion of an arteriovenous fistula or graft, was recorded. Risk factors for thrombotic events were analyzed by multivariable competing risk regression.

Results

VTE and VAT events occurred with an incidence rate of 1.7 (95% confidence interval [CI]: 1.2–2.6) and 7.6 per 100 person-years (95% CI: 6.3–9.3), respectively. The 30-day case fatality rates were 20.8 and 4.1% for VTE and VAT events, respectively. Prior VAT (hazard ratio [HR]: 3.07, 95% CI: 1.33–7.11, p = 0.009) and nephrectomy (HR: 6.53, 95% CI: 2.23–19.14, p = 0.001) were significantly associated with increased risk of VTE occurrence. Prior VAT was associated with a 1.8-fold (95% CI: 1.18–2.65, p = 0.006) and nephrectomy with a 2.8-fold increased risk of VAT occurrence (95% CI: 1.45–5.57, p = 0.002). Patients on vitamin K antagonists were protected from VTE (HR: 0.001, 95% CI: <0.01– < 0.01, p < 0.001) compared with nonusers but had no benefit with regard to VAT events.

Conclusion

Identifying patients at high risk of thrombotic complications using risk factors, such as a history of nephrectomy and prior thrombotic events, may facilitate preventive measures.

Keywords

anticoagulants - chronic kidney disease - hemodialysis - renal replacement therapy - vascular access - venous thromboembolism - thrombosis


Publication History

Received: 06 June 2025

Accepted: 11 September 2025

Article published online:
24 September 2025

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