(Circulation. 1999;99:2530-2536.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Antibodies to Platelet Factor 4–Heparin After Cardiopulmonary Bypass in Patients Anticoagulated With Unfractionated Heparin or a Low-Molecular-Weight Heparin
Clinical Implications for Heparin-Induced Thrombocytopenia
From the Departments of Hematology (C.P., S.I., Y.G.), Anesthesiology (M.A.M.), and Cardiac Surgery (M.M.), Hôpital Trousseau, Tours, and the Department of Immunology (J.A., A.M.V.), Serbio, Gennevilliers, France.
Correspondence to Dr Yves Gruel, MD, Department of Hematology, Hôpital Trousseau, 37044 Tours Cedex, France. E-mail gruel{at}med.univ-tours.fr
Background—Cardiopulmonary bypass (CPB) induces platelet activation with release of platelet factor 4 (PF4), and patients are exposed to high doses of heparin (H). We investigated whether this contributes to the development of antibodies to H-PF4 and heparin-induced thrombocytopenia (HIT).
Methods and Results—CPB was performed with unfractionated heparin
(UFH) in 328 patients. After surgery, patients received UFH (calcium
heparin, 200 IU · kg-1 · d-1)
(group 1, n=157) or low-molecular-weight heparin (LMWH, Dalteparin,
5000 IU once daily) (group 2, n=171). Eight days after surgery,
antibodies to H-PF4 were present in 83 patients (25.3%), 46 in
group 1 and 37 in group 2 (P=0.12). Most patients (61%)
had IgG1 to H-PF4, but only 8 samples with antibodies induced
platelet activation with positive results on serotonin
release assay. HIT occurred in 6 patients in group 1, but no
thrombocytopenia was observed in subjects receiving LMWH, although 2
had high levels of antibodies with positive serotonin
release assay results. When antibodies to H-PF4 were present, mean
platelet counts were lower only in patients with Fc
RIIA
R/R131 platelets.
Conclusions—These results provide evidence that the development of antibodies to H-PF4 after CPB performed with UFH is not influenced by the postoperative heparin treatment. The antibodies associated with high risk of HIT are mainly IgG1, which is present at high titers in the plasma of patients continuously treated with UFH.
Key Words: cardiopulmonary bypass • heparin • platelets • antibodies
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