Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery

Brendan M. Everett, Robert Yeh, Shi Yin Foo, David Criss, Elizabeth M. Van Cott, Michael Laposata, Edwin G. Avery, William D. Hoffman, Jennifer Walker, David Torchiana, Ik Kyung Jang

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: The clinical significance of heparin/platelet factor 4 (PF4) antibodies in subjects undergoing cardiac surgery has not been systematically studied. We prospectively investigated whether the presence of heparin/PF4 antibodies would predict clinical thrombosis in this population. Methods: In 299 patients scheduled for cardiac surgery between October 2003 and March 2005, the heparin/PF4 antibodies and platelet count were measured immediately prior to, and 5 days after, surgery. The patients were followed up at 30 days for thrombotic complications. Results: The prevalence of the heparin/PF4 antibodies was 4.3% (13 of 299) prior to surgery and increased more than fivefold to 22.4% (62 of 277) postoperatively (p < 0.0001). Thromboembolic events occurred in 8.8% of patients with negative antibody and in 6.3% of patients with positive antibody (p = 0.77). Of the 62 patients with positive heparin/PF4 antibodies postoperatively, 22 (35.5%) were treated with a nonheparin anticoagulant. There was a trend toward higher rates of thromboembolic events in subjects who were thrombocytopenic compared with those who were not (17.1% and 6.7%, respectively, p = 0.06), regardless of antibody status. Two out of 8 patients (25%) with both thrombocytopenia and a positive antibody (clinical heparin-induced thrombocytopenia [HIT]) suffered a thromboembolic event, compared with 17 of 222 (7.7%) without clinical HIT (p = 0.13). Conclusions: The high prevalence of antibodies to the heparin/PF4 complex after cardiac surgery and the low rate of thromboembolic complications in this population suggest that the antibody alone does not confer an increased risk of thrombotic complications. Monitoring for thrombocytopenia is recommended.

Original languageEnglish (US)
Pages (from-to)592-597
Number of pages6
JournalAnnals of Thoracic Surgery
Volume83
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

Platelet Factor 4
Thoracic Surgery
Heparin
Antibodies
Thrombocytopenia
Ambulatory Surgical Procedures
Platelet Count
Anticoagulants
Population
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery. / Everett, Brendan M.; Yeh, Robert; Foo, Shi Yin; Criss, David; Van Cott, Elizabeth M.; Laposata, Michael; Avery, Edwin G.; Hoffman, William D.; Walker, Jennifer; Torchiana, David; Jang, Ik Kyung.

In: Annals of Thoracic Surgery, Vol. 83, No. 2, 02.2007, p. 592-597.

Research output: Contribution to journalArticle

Everett, BM, Yeh, R, Foo, SY, Criss, D, Van Cott, EM, Laposata, M, Avery, EG, Hoffman, WD, Walker, J, Torchiana, D & Jang, IK 2007, 'Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery', Annals of Thoracic Surgery, vol. 83, no. 2, pp. 592-597. https://doi.org/10.1016/j.athoracsur.2006.09.040
Everett, Brendan M. ; Yeh, Robert ; Foo, Shi Yin ; Criss, David ; Van Cott, Elizabeth M. ; Laposata, Michael ; Avery, Edwin G. ; Hoffman, William D. ; Walker, Jennifer ; Torchiana, David ; Jang, Ik Kyung. / Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 2. pp. 592-597.
@article{58cd5960880f4608abe764cd4bf7825f,
title = "Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery",
abstract = "Background: The clinical significance of heparin/platelet factor 4 (PF4) antibodies in subjects undergoing cardiac surgery has not been systematically studied. We prospectively investigated whether the presence of heparin/PF4 antibodies would predict clinical thrombosis in this population. Methods: In 299 patients scheduled for cardiac surgery between October 2003 and March 2005, the heparin/PF4 antibodies and platelet count were measured immediately prior to, and 5 days after, surgery. The patients were followed up at 30 days for thrombotic complications. Results: The prevalence of the heparin/PF4 antibodies was 4.3{\%} (13 of 299) prior to surgery and increased more than fivefold to 22.4{\%} (62 of 277) postoperatively (p < 0.0001). Thromboembolic events occurred in 8.8{\%} of patients with negative antibody and in 6.3{\%} of patients with positive antibody (p = 0.77). Of the 62 patients with positive heparin/PF4 antibodies postoperatively, 22 (35.5{\%}) were treated with a nonheparin anticoagulant. There was a trend toward higher rates of thromboembolic events in subjects who were thrombocytopenic compared with those who were not (17.1{\%} and 6.7{\%}, respectively, p = 0.06), regardless of antibody status. Two out of 8 patients (25{\%}) with both thrombocytopenia and a positive antibody (clinical heparin-induced thrombocytopenia [HIT]) suffered a thromboembolic event, compared with 17 of 222 (7.7{\%}) without clinical HIT (p = 0.13). Conclusions: The high prevalence of antibodies to the heparin/PF4 complex after cardiac surgery and the low rate of thromboembolic complications in this population suggest that the antibody alone does not confer an increased risk of thrombotic complications. Monitoring for thrombocytopenia is recommended.",
author = "Everett, {Brendan M.} and Robert Yeh and Foo, {Shi Yin} and David Criss and {Van Cott}, {Elizabeth M.} and Michael Laposata and Avery, {Edwin G.} and Hoffman, {William D.} and Jennifer Walker and David Torchiana and Jang, {Ik Kyung}",
year = "2007",
month = "2",
doi = "10.1016/j.athoracsur.2006.09.040",
language = "English (US)",
volume = "83",
pages = "592--597",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery

AU - Everett, Brendan M.

AU - Yeh, Robert

AU - Foo, Shi Yin

AU - Criss, David

AU - Van Cott, Elizabeth M.

AU - Laposata, Michael

AU - Avery, Edwin G.

AU - Hoffman, William D.

AU - Walker, Jennifer

AU - Torchiana, David

AU - Jang, Ik Kyung

PY - 2007/2

Y1 - 2007/2

N2 - Background: The clinical significance of heparin/platelet factor 4 (PF4) antibodies in subjects undergoing cardiac surgery has not been systematically studied. We prospectively investigated whether the presence of heparin/PF4 antibodies would predict clinical thrombosis in this population. Methods: In 299 patients scheduled for cardiac surgery between October 2003 and March 2005, the heparin/PF4 antibodies and platelet count were measured immediately prior to, and 5 days after, surgery. The patients were followed up at 30 days for thrombotic complications. Results: The prevalence of the heparin/PF4 antibodies was 4.3% (13 of 299) prior to surgery and increased more than fivefold to 22.4% (62 of 277) postoperatively (p < 0.0001). Thromboembolic events occurred in 8.8% of patients with negative antibody and in 6.3% of patients with positive antibody (p = 0.77). Of the 62 patients with positive heparin/PF4 antibodies postoperatively, 22 (35.5%) were treated with a nonheparin anticoagulant. There was a trend toward higher rates of thromboembolic events in subjects who were thrombocytopenic compared with those who were not (17.1% and 6.7%, respectively, p = 0.06), regardless of antibody status. Two out of 8 patients (25%) with both thrombocytopenia and a positive antibody (clinical heparin-induced thrombocytopenia [HIT]) suffered a thromboembolic event, compared with 17 of 222 (7.7%) without clinical HIT (p = 0.13). Conclusions: The high prevalence of antibodies to the heparin/PF4 complex after cardiac surgery and the low rate of thromboembolic complications in this population suggest that the antibody alone does not confer an increased risk of thrombotic complications. Monitoring for thrombocytopenia is recommended.

AB - Background: The clinical significance of heparin/platelet factor 4 (PF4) antibodies in subjects undergoing cardiac surgery has not been systematically studied. We prospectively investigated whether the presence of heparin/PF4 antibodies would predict clinical thrombosis in this population. Methods: In 299 patients scheduled for cardiac surgery between October 2003 and March 2005, the heparin/PF4 antibodies and platelet count were measured immediately prior to, and 5 days after, surgery. The patients were followed up at 30 days for thrombotic complications. Results: The prevalence of the heparin/PF4 antibodies was 4.3% (13 of 299) prior to surgery and increased more than fivefold to 22.4% (62 of 277) postoperatively (p < 0.0001). Thromboembolic events occurred in 8.8% of patients with negative antibody and in 6.3% of patients with positive antibody (p = 0.77). Of the 62 patients with positive heparin/PF4 antibodies postoperatively, 22 (35.5%) were treated with a nonheparin anticoagulant. There was a trend toward higher rates of thromboembolic events in subjects who were thrombocytopenic compared with those who were not (17.1% and 6.7%, respectively, p = 0.06), regardless of antibody status. Two out of 8 patients (25%) with both thrombocytopenia and a positive antibody (clinical heparin-induced thrombocytopenia [HIT]) suffered a thromboembolic event, compared with 17 of 222 (7.7%) without clinical HIT (p = 0.13). Conclusions: The high prevalence of antibodies to the heparin/PF4 complex after cardiac surgery and the low rate of thromboembolic complications in this population suggest that the antibody alone does not confer an increased risk of thrombotic complications. Monitoring for thrombocytopenia is recommended.

UR - http://www.scopus.com/inward/record.url?scp=33846384287&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846384287&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2006.09.040

DO - 10.1016/j.athoracsur.2006.09.040

M3 - Article

VL - 83

SP - 592

EP - 597

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -