PMID- 26659923
OWN - NLM
STAT- MEDLINE
DCOM- 20160808
LR  - 20210202
IS  - 1528-0020 (Electronic)
IS  - 0006-4971 (Print)
IS  - 0006-4971 (Linking)
VI  - 127
IP  - 8
DP  - 2016 Feb 25
TI  - Mechanical prophylaxis is a heparin-independent risk for anti-platelet factor 
      4/heparin antibody formation after orthopedic surgery.
PG  - 1036-43
LID - 10.1182/blood-2015-06-651620 [doi]
AB  - Platelet-activating antibodies, which recognize platelet factor 4 (PF4)/heparin 
      complexes, induce spontaneous heparin-induced thrombocytopenia (HIT) syndrome or 
      fondaparinux-associated HIT without exposure to unfractionated heparin (UFH) or 
      low-molecular-weight heparin (LMWH). This condition mostly occurs after major 
      orthopedic surgery, implying that surgery itself could trigger this immune 
      response, although the mechanism is unclear. To investigate how surgery may do 
      so, we performed a multicenter, prospective study of 2069 patients who underwent 
      total knee arthroplasty (TKA) or hip arthroplasty. Approximately half of the 
      patients received postoperative thromboprophylaxis with UFH, LMWH, or 
      fondaparinux. The other half received only mechanical thromboprophylaxis, 
      including dynamic (intermittent plantar or pneumatic compression device), static 
      (graduated compression stockings [GCSs]), or both. We measured anti-PF4/heparin 
      immunoglobulins G, A, and M before and 10 days after surgery using an 
      immunoassay. Multivariate analysis revealed that dynamic mechanical 
      thromboprophylaxis (DMT) was an independent risk factor for seroconversion (odds 
      ratio [OR], 2.01; 95% confidence interval [CI], 1.34-3.02; P = .001), which was 
      confirmed with propensity-score matching (OR, 1.99; 95% CI, 1.17-3.37; P = .018). 
      For TKA, the seroconversion rates in patients treated with DMT but no 
      anticoagulation and in patients treated with UFH or LMWH without DMT were 
      similar, but significantly higher than in patients treated with only GCSs. The 
      proportion of patients with >/=1.4 optical density units appeared to be higher 
      among those treated with any anticoagulant plus DMT than among those not treated 
      with DMT. Our study suggests that DMT increases risk of an anti-PF4/heparin 
      immune response, even without heparin exposure. This trial was registered to 
      www.umin.ac.jp/ctr as #UMIN000001366.
CI  - (c) 2016 by The American Society of Hematology.
FAU - Bito, Seiji
AU  - Bito S
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan; Division of Clinical 
      Epidemiology, NHO Tokyo Medical Center, Tokyo, Japan;
FAU - Miyata, Shigeki
AU  - Miyata S
AD  - Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, 
      Osaka, Japan;
FAU - Migita, Kiyoshi
AU  - Migita K
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Nakamura, Mashio
AU  - Nakamura M
AD  - Department of Cardiology and Nephrology, Mie University Graduate School of 
      Medicine, Mie, Japan;
FAU - Shinohara, Kazuhito
AU  - Shinohara K
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Sato, Tomotaro
AU  - Sato T
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Tonai, Takeharu
AU  - Tonai T
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Shimizu, Motoyuki
AU  - Shimizu M
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Shibata, Yasuhiro
AU  - Shibata Y
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Kishi, Kazuhiko
AU  - Kishi K
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Kubota, Chikara
AU  - Kubota C
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Nakahara, Shinnosuke
AU  - Nakahara S
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Mori, Toshihito
AU  - Mori T
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Ikeda, Kazuo
AU  - Ikeda K
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Ota, Shusuke
AU  - Ota S
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Minamizaki, Takeshi
AU  - Minamizaki T
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Yamada, Shigeru
AU  - Yamada S
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Shiota, Naofumi
AU  - Shiota N
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan;
FAU - Kamei, Masataka
AU  - Kamei M
AD  - Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, 
      Japan; and.
FAU - Motokawa, Satoru
AU  - Motokawa S
AD  - Japanese National Hospital Organization (NHO)-Evidence-Based Medicine Study Group 
      for the Clinical Study of Prevention and Actual Situation of Venous 
      Thromboembolism After Total Arthroplasty, Tokyo, Japan; Department of Orthopedic 
      Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan.
LA  - eng
SI  - JPRN/UMIN000001366
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151209
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
RN  - 0 (Anticoagulants)
RN  - 0 (Autoantibodies)
RN  - 0 (Autoantigens)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Polysaccharides)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
CIN - Blood. 2016 Feb 25;127(8):961-2. PMID: 26917737
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Arthroplasty, Replacement, Hip/*adverse effects
MH  - Arthroplasty, Replacement, Knee/*adverse effects
MH  - Autoantibodies/*blood/immunology
MH  - Autoantigens/immunology
MH  - Cohort Studies
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Female
MH  - Fondaparinux
MH  - Heparin/immunology/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Intermittent Pneumatic Compression Devices
MH  - Male
MH  - Middle Aged
MH  - Platelet Factor 4/immunology
MH  - Polysaccharides/therapeutic use
MH  - Stockings, Compression
MH  - Thromboembolism/*prevention & control
PMC - PMC4768427
EDAT- 2015/12/15 06:00
MHDA- 2016/08/09 06:00
PMCR- 2016/02/25
CRDT- 2015/12/15 06:00
PHST- 2015/06/16 00:00 [received]
PHST- 2015/12/01 00:00 [accepted]
PHST- 2015/12/15 06:00 [entrez]
PHST- 2015/12/15 06:00 [pubmed]
PHST- 2016/08/09 06:00 [medline]
PHST- 2016/02/25 00:00 [pmc-release]
AID - S0006-4971(20)30424-9 [pii]
AID - 2015/651620 [pii]
AID - 10.1182/blood-2015-06-651620 [doi]
PST - ppublish
SO  - Blood. 2016 Feb 25;127(8):1036-43. doi: 10.1182/blood-2015-06-651620. Epub 2015 
      Dec 9.