PMID- 19965682
OWN - NLM
STAT- MEDLINE
DCOM- 20100402
LR  - 20210206
IS  - 1528-0020 (Electronic)
IS  - 0006-4971 (Linking)
VI  - 115
IP  - 9
DP  - 2010 Mar 4
TI  - The severity of trauma determines the immune response to PF4/heparin and the 
      frequency of heparin-induced thrombocytopenia.
PG  - 1797-803
LID - 10.1182/blood-2009-07-231506 [doi]
AB  - Heparin can induce heparin-induced thrombocytopenia (HIT). The combined effect of 
      type of surgery (major vs minor) and heparin on this prothrombotic immune 
      reaction to platelet factor 4 (PF4)/heparin was analyzed. In a randomized, 
      double-blind study, trauma patients receiving low-molecular-weight (LMWH) or 
      unfractionated heparin (UFH) for thrombosis prophylaxis were assessed for 
      PF4/heparin-antibody seroconversion, HIT, and thrombosis according to type of 
      surgery. The risk for seroconversion was higher than major versus minor surgery 
      odds ratio, 7.98 [95% confidence interval, 2.06-31.00], P = .003, controlled for 
      potential confounders, as was the risk for HIT (2.2% [95% confidence interval, 
      0.3%-4.1%] vs 0.0%, P = .010). During LMWH compared with UFH thromboprophylaxis, 
      HIT (1 of 298 vs 4 of 316; P = .370) and PF4/heparin seroconversion (1.7% vs 
      6.6%; P = .002) were less frequent, driven by differences in patients undergoing 
      major surgery (incidence of HIT: LMWH 0.8% vs UFH 4.0%; P = .180; seroconversion 
      rates: 4.0% vs 17.0%; P = .001). After minor surgery, no case of HIT occurred. 
      The severity of trauma and the need for major surgery strongly influence the risk 
      of an anti-PF4/heparin immune response, which is then increased by UFH. In major 
      trauma certoparin may be safer than UFH because it induces HIT-antibody 
      seroconversion, and the corresponding risk of HIT, less frequently.
FAU - Lubenow, Norbert
AU  - Lubenow N
AD  - Institut fur Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universitat, 
      Greifswald.
FAU - Hinz, Peter
AU  - Hinz P
FAU - Thomaschewski, Simone
AU  - Thomaschewski S
FAU - Lietz, Theresia
AU  - Lietz T
FAU - Vogler, Michael
AU  - Vogler M
FAU - Ladwig, Andrea
AU  - Ladwig A
FAU - Junger, Michael
AU  - Junger M
FAU - Nauck, Matthias
AU  - Nauck M
FAU - Schellong, Sebastian
AU  - Schellong S
FAU - Wander, Kathrin
AU  - Wander K
FAU - Engel, Georg
AU  - Engel G
FAU - Ekkernkamp, Axel
AU  - Ekkernkamp A
FAU - Greinacher, Andreas
AU  - Greinacher A
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20091120
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Blood. 2010 Mar 4;115(9):1664-5. PMID: 20203271
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/adverse effects/immunology
MH  - Double-Blind Method
MH  - Female
MH  - Heparin/*adverse effects/*immunology
MH  - Heparin, Low-Molecular-Weight/adverse effects/immunology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Factor 4/*immunology
MH  - Postoperative Complications/prevention & control
MH  - Risk Factors
MH  - Thrombocytopenia/*chemically induced/immunology
MH  - Thrombosis/prevention & control
MH  - Wounds and Injuries/complications/*drug therapy/*immunology
MH  - Young Adult
EDAT- 2009/12/08 06:00
MHDA- 2010/04/03 06:00
CRDT- 2009/12/08 06:00
PHST- 2009/12/08 06:00 [entrez]
PHST- 2009/12/08 06:00 [pubmed]
PHST- 2010/04/03 06:00 [medline]
AID - S0006-4971(20)56705-0 [pii]
AID - 10.1182/blood-2009-07-231506 [doi]
PST - ppublish
SO  - Blood. 2010 Mar 4;115(9):1797-803. doi: 10.1182/blood-2009-07-231506. Epub 2009 
      Nov 20.