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
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
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DOI：
10.1161/01.cir.99.19.2530
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发表时间：
1999-05-18
期刊：
影响因子：
37.8
通讯作者：
Gruel, Y
中科院分区：
文献类型：
--
作者：
Pouplard, C;May, MA;Gruel, Y
背景-心肺转流术 (CPB) 会诱导血小板活化并释放血小板因子 4 (PF4)，并且患者会暴露于高剂量的肝素 (H)。我们研究了这是否有助于 H-PF4 抗体的产生和肝素诱导的血小板减少症 (HIT)。方法和结果 - 对 328 名患者使用普通肝素 (UFH) 进行体外循环。手术后，患者接受UFH（肝素钙，200 IU.kg(-1).d(-1)）（第1组，n=157）或低分子肝素（LMWH，达肝素，5000 TU，每日一次）（第2组，n=171）。术后八天，83 名患者 (25.3%) 中出现 H-PF 1 抗体，其中第 1 组有 46 名患者，第 2 组有 37 名患者 (P=0.12)。大多数患者 (61%) 具有 IgG 1 至 H-PF4，但只有 8 个样本具有诱导血小板活化的抗体，且血清素释放测定呈阳性结果。第 1 组中有 6 名患者发生 HIT，但在接受 LMWH 的受试者中未观察到血小板减少症，尽管 2 名受试者的抗体水平较高且血清素释放测定结果呈阳性。当存在 H-PF4 抗体时，仅 Fc gamma RIIA R/R-131 血小板患者的平均血小板计数较低。结论 - 这些结果提供证据表明，在 UFH 进行 CPB 后 H-PF4 抗体的产生不受术后肝素治疗的影响。与HIT高风险相关的抗体主要是IgG1，其在持续接受UR-I治疗的患者的血浆中以高滴度存在。
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 TU once daily) (group 2, n=171). Eight days after surgery, antibodies to H-PF 1 were present in 83 patients (25.3%), 46 in group 1 and 37 in group 2 (P=0.12). Most patients (61%) had IgG 1 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 gamma RIIA R/R-131 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 UR-I.