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The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery.

Publication ,  Journal Article
Welsby, IJ; Krakow, EF; Heit, JA; Williams, EC; Arepally, GM; Bar-Yosef, S; Kong, DF; Martinelli, S; Dhakal, I; Liu, WW; Krischer, J; Ortel, TL
Published in: J Thromb Haemost
January 2017

UNLABELLED: Essentials We evaluated antibody status, thromboembolism and survival after cardiac surgery. Positive antibody tests are common - over 50% are seropositive at 30 days. Seropositivity did not increase thromboembolism or impair survival after cardiac surgery. Results show heparin induced thrombocytopenia antibody screening after surgery is not warranted. SUMMARY: Background Heparin-induced thrombocytopenia (HIT) is a prothrombotic response to heparin therapy with platelet-activating, anti-platelet factor 4 (PF4)/heparin antibodies leading to thrombocytopenia associated with thromboembolism. Objective We tested the hypothesis that anti-PF4/heparin antibodies are associated with thromboembolism after cardiac surgery. Methods This multicenter, prospective cohort study collected laboratory and clinical data up to 30 days after surgery and longer-term clinical follow-up data. The primary outcome variable combined new arterial or venous thromboembolic complications (TECs) with all-cause death until 90 days after surgery. Laboratory analyses included platelet counts and anti-PF4/heparin antibody titers (GTI ELISA), with a confirmatory excess heparin step and serotonin release assay. Chi-square testing was used to test the relationship between our outcome and HIT antibody seropositivity. Results Initially, 1021 patients were enrolled between August 2006 and May 2009, and follow-up was completed in December 2014. Seropositivity defined by OD > 0.4 was common, being almost 20% preoperatively, > 30% by discharge, and > 60% by day 30. Death (1.7% within 30 days) or TECs (69 in total) were more likely if the partient was seronegative (OD < 0.4), but positivity defined by OD > 1.0 or including an excess heparin confirmatory step resulted in equal incidence of death or TECs, whether the patient was seronegative or seropositive. Incorporating the serotonin release assay for platelet-activating antibodies did not alter these findings. Conclusions Seropositivity for anti-PF4/heparin antibodies does not increase the risk of death or thromboembolism after cardiac surgery. Screening is not indicated, and seropositivity should only be interpreted in the context of clinical evidence for HIT. TRIAL REGISTRATION: Duke IRB Protocol #00010736.

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Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

January 2017

Volume

15

Issue

1

Start / End Page

57 / 65

Location

England

Related Subject Headings

  • Treatment Outcome
  • Thromboembolism
  • Thrombocytopenia
  • Sample Size
  • Prospective Studies
  • Platelet Factor 4
  • Platelet Count
  • Middle Aged
  • Male
  • Humans
 

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Welsby, I. J., Krakow, E. F., Heit, J. A., Williams, E. C., Arepally, G. M., Bar-Yosef, S., … Ortel, T. L. (2017). The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery. J Thromb Haemost, 15(1), 57–65. https://doi.org/10.1111/jth.13533
Welsby, I. J., E. F. Krakow, J. A. Heit, E. C. Williams, G. M. Arepally, S. Bar-Yosef, D. F. Kong, et al. “The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery.J Thromb Haemost 15, no. 1 (January 2017): 57–65. https://doi.org/10.1111/jth.13533.
Welsby IJ, Krakow EF, Heit JA, Williams EC, Arepally GM, Bar-Yosef S, et al. The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery. J Thromb Haemost. 2017 Jan;15(1):57–65.
Welsby, I. J., et al. “The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery.J Thromb Haemost, vol. 15, no. 1, Jan. 2017, pp. 57–65. Pubmed, doi:10.1111/jth.13533.
Welsby IJ, Krakow EF, Heit JA, Williams EC, Arepally GM, Bar-Yosef S, Kong DF, Martinelli S, Dhakal I, Liu WW, Krischer J, Ortel TL. The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery. J Thromb Haemost. 2017 Jan;15(1):57–65.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

January 2017

Volume

15

Issue

1

Start / End Page

57 / 65

Location

England

Related Subject Headings

  • Treatment Outcome
  • Thromboembolism
  • Thrombocytopenia
  • Sample Size
  • Prospective Studies
  • Platelet Factor 4
  • Platelet Count
  • Middle Aged
  • Male
  • Humans