Predictors for the development of elevated anti-heparin/platelet factor 4 antibody titers in patients undergoing cardiac catheterization.
A substantial proportion of patients who undergo cardiac catheterization develop antibodies directed against the heparin/platelet factor 4 (PF4) complex after the procedure, which have been implicated in the pathogenesis of heparin-induced thrombocytopenia. This study attempted to identify factors that predicted the development of these antibodies in a prospective cohort study. Antiheparin/PF4 antibody titers were measured at baseline and again 5 +/- 2 days after cardiac catheterization by enzyme-linked immunosorbent assay. A total of 311 patients who underwent cardiac catheterization were included in the analysis. Of these, 25 (8.0%) developed positive antibody levels after catheterization. Patients who had positive antibody test results after catheterization had significantly greater baseline antiheparin/PF4 antibody titers compared with those whose titers remained low (optical density 0.227 vs 0.158, p < 0.001). In a logistic regression model, greater baseline antibody titers, a history of heparin exposure, and a lower platelet count at enrollment were the strongest predictors of conversion to positive antiheparin/PF4 antibody titers after cardiac catheterization. It is possible to identify patients at high risk for developing elevated titers of antiheparin/PF4 antibodies on the basis of their baseline clinical characteristics.
Yeh
Robert W
RW
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Everett
Brendan M
BM
Foo
Shi-Yin
SY
Dorer
David J
DJ
Laposata
Michael
M
Van Cott
Elizabeth M
EM
Jang
Ik-Kyung
IK
D000906:Antibodies / Q000276:immunology*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced / Q000276:immunology*
D000906:Antibodies; D000925:Anticoagulants; D010978:Platelet Factor 4; D006493:Heparin