Thrombosis in Suspected Heparin-induced Thrombocytopenia Occurs More Often with High Antibody Levels
Thrombosis in Suspected Heparin-induced Thrombocytopenia Occurs More Often with High Antibody Levels
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DOI：
10.1016/j.amjmed.2011.06.025
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发表时间：
2012-01-01
影响因子：
5.9
通讯作者：
Goldhaber, Samuel Z.
中科院分区：
文献类型：
--
作者：
Baroletti, Steven;Hurwitz, Shelley;Goldhaber, Samuel Z.
目的：本研究的目的是确定使用酶联免疫吸附试验测定的较高抗血小板因子4（PF 4）/肝素抗体水平是否与临床疑似肝素诱导的血小板减少症患者更频繁的血栓形成事件相关。肝素诱导的血小板减少症是一种免疫介导的药物不良反应。酶联免疫吸附试验检测抗PF 4/肝素抗体，以支持肝素诱导的血小板减少症的疑似临床诊断。定量酶联免疫吸附试验结果的实用性尚不确定。方法：我们的单中心研究使用酶联免疫吸附试验评价了2003年7月至2006年12月期间连续住院患者的定量抗PF 4/肝素抗体水平，这些患者临床怀疑为肝素诱导的血小板减少症且抗PF 4/肝素抗体水平阳性。总体而言，318例临床疑似肝素诱导的血小板减少症患者的抗PF 4/肝素抗体值可用。中位水平为0.85光密度单位（范围0.31-4.0）。动脉或静脉血栓形成的总发生率为23.3%。抗PF 4/肝素抗体水平每增加1个单位，30天内血栓形成的几率大约增加一倍（比值比，1.9; 95%置信区间，1.5-2.6; P = 0.0001）。肺栓塞患者的比例增加与较高的抗PF 4/肝素抗体levels.CONCLUSION：较高水平的抗PF 4/肝素抗体与临床怀疑肝素诱导的血小板减少症患者血栓形成的风险增加，并可能具有临床实用性的预测真正的肝素诱导的血小板减少症和血栓形成的发展。(C)2012 Elsevier Inc. All rights reserved. .美国医学杂志（2012）125，44-49
OBJECTIVE: The study objective was to determine whether higher antiplatelet factor 4 (PF4)/heparin antibody levels using an enzyme-linked immunosorbent assay are associated with more frequent thrombotic events in patients with clinically suspected heparin-induced thrombocytopenia. Heparin-induced thrombocytopenia is an immune-mediated adverse drug reaction. An enzyme-linked immunosorbent assay detects anti-PF4/heparin antibodies to support a suspected clinical diagnosis of heparin-induced thrombocytopenia. The utility of quantitative enzyme-linked immunosorbent assay results is uncertain.METHODS: Our single-centered study evaluated quantitative anti-PF4/heparin antibody levels using an enzyme-linked immunosorbent assay in consecutive hospitalized patients with a clinical suspicion of heparin-induced thrombocytopenia and positive anti-PF4/heparin antibody levels between July 2003 and December 2006.RESULTS: Overall, anti-PF4/heparin antibody values were available for 318 patients with clinically suspected heparin-induced thrombocytopenia. The median level was 0.85 optical density units (range 0.31-4.0). The overall rate of arterial or venous thrombosis was 23.3%. A 1-unit increase in anti-PF4/heparin antibody level was associated with an approximate doubling in the odds of thrombosis by 30 days (odds ratio, 1.9; 95% confidence interval, 1.5-2.6; P = .0001). The proportion of patients with pulmonary embolism increased with higher anti-PF4/heparin antibody levels.CONCLUSION: Higher levels of anti-PF4/heparin antibody are associated with increased thrombosis risk among patients with clinically suspected heparin-induced thrombocytopenia and might have clinical utility for prediction of true heparin-induced thrombocytopenia and the development of thrombosis. (C) 2012 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2012) 125, 44-49