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Heparin-platelet factor 4 antibodies are frequent after vascular surgery but are not a frequent cause of graft thrombosis or thrombocytopenia.

Abstract：

OBJECTIVE:Approximately 10% of infrainguinal bypass surgeries are complicated by early conduit failure. The cause is unclear in most cases. A prospective study was conducted to monitor the development and function of platelet factor 4 (PF4)/heparin antibodies after infrainguinal bypass procedures and to evaluate their clinical significance in early graft occlusion. METHODS:Blood samples were obtained before surgery and at the 7-, 14-, and 28-day postsurgical evaluation. Relevant demographic and laboratory data were collected, and plasma samples were assayed for the presence and function of PF4/heparin-antibody by enzyme-linked immunosorbent assay (ELISA) and a two-point platelet aggregation assay. All tests were performed in duplicate or triplicate. RESULTS:Of the 79 patients who were enrolled, 67 reported previous heparin exposure. Six patients (7.6%) tested positive for the presence of PF4/heparin antibodies before surgery with ELISA, and four of these (67%) also had a positive result on the aggregation assay. During the 28-day follow-up, 22 subjects (32%) converted to positive according to the ELISA results; and five (22.7%) of these also tested positive for platelet-activating antibodies. No participants presented with thrombocytopenia or a >/=50% decrease in platelet count during the study period. Early graft occlusion was detected in three patients, all with negative ELISA and functional assay results throughout the study. CONCLUSION:Patients undergoing vascular surgery frequently develop PF4/heparin antibodies, with platelet-activating antibodies detected in up to 11% of these individuals. However, thrombocytopenia and vascular graft thrombosis both appear to be an uncommon consequence.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Alexy T,Tucker S,Boyle S,Rowe VL,Weaver FA,Liebman HA

doi

10.1016/j.jvs.2008.03.028

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

377-81

issue

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(08)00440-0

journal_volume

pub_type

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Heparin-platelet factor 4 antibodies are frequent after vascular surgery but are not a frequent cause of graft thrombosis or thrombocytopenia.