PMID- 10330384
OWN - NLM
STAT- MEDLINE
DCOM- 19990608
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 99
IP  - 19
DP  - 1999 May 18
TI  - 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.
PG  - 2530-6
AB  - 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 FcgammaRIIA 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.
FAU - Pouplard, C
AU  - Pouplard C
AD  - Departments of Hematology, Anesthesiology and Cardiac Surgery, Gennevilliers, 
      France.
FAU - May, M A
AU  - May MA
FAU - Iochmann, S
AU  - Iochmann S
FAU - Amiral, J
AU  - Amiral J
FAU - Vissac, A M
AU  - Vissac AM
FAU - Marchand, M
AU  - Marchand M
FAU - Gruel, Y
AU  - Gruel Y
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Antibodies)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antibodies/blood/immunology
MH  - *Cardiopulmonary Bypass
MH  - Female
MH  - Heparin/*adverse effects/*immunology/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Factor 4/*immunology
MH  - Postoperative Complications/*prevention & control
MH  - Thrombocytopenia/*chemically induced/*immunology
EDAT- 1999/05/20 00:00
MHDA- 1999/05/20 00:01
CRDT- 1999/05/20 00:00
PHST- 1999/05/20 00:00 [pubmed]
PHST- 1999/05/20 00:01 [medline]
PHST- 1999/05/20 00:00 [entrez]
AID - 10.1161/01.cir.99.19.2530 [doi]
PST - ppublish
SO  - Circulation. 1999 May 18;99(19):2530-6. doi: 10.1161/01.cir.99.19.2530.