Clinical relevance of heparin-PF4 complex antibody in DVT after total joint replacement.
BACKGROUND
Antibodies to the heparin-platelet factor-4 (HPF-4) complex (HIT antibodies) have been observed in patients with heparin-induced thrombocytopenia (HIT). These antibodies are thought to be involved in thrombosis through activation of platelet/endothelial cells. This prospective study was conducted to determine the incidence of post-operative HIT antibodies to assess the associated risk of deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).


METHODS
We studied 104 patients who underwent unilateral primary TKA (n = 44) and primary THA (n = 60) with short-duration prophylaxis (1-2 days of a fixed dose of unfractionated heparin). HIT antibodies were assayed using a sandwich-type ELISA before the operation and after heparin treatment (post-operative day 7).


RESULTS
In the clinical outcome, the incidence of symptomatic DVT was 15.4% (16/104, TKA; 10, THA 6) and pulmonary embolism (PE) was not observed. The total seroconversion rate of HIT antibodies at post-operative day 7 was 34.6% (36/104). Among 36 seroconverted patients, 11 (30.6%) developed symptomatic DVT and 5 out of 68 of the non-seroconverted patients (7.4%) developed symptomatic DVT. The incidence for DVT was significantly higher in the seroconverted patients compared with that of the non-seroconverted patients (odds ratio 5.5, 95%CI: 1.7-17.6 p = 0.0028). Furthermore, in the patients with symptomatic DVT, the titer of HIT antibodies at post-operative day 7 was significantly higher compared with those without symptomatic DVT.


CONCLUSIONS
Our data therefore suggest that seroconversion for HIT antibodies generated by heparin is associated with a risk of DVT in patients undergoing total joint replacement.
Torigoshi
Takafumi
T
1Department of Orthopedics Surgery and Department of Rheumatology, NHO Nagasaki Medical Center, Nagasaki, Japan. ttorigoshi@nmc.hosp.go.jp
Motokawa
Satoru
S
Maeda
Yumi
Y
Maeda
Kazushige
K
Hiura
Takeshi
T
Takayama
Gou
G
Taguchi
Kenji
K
Shindo
Hiroyuki
H
Migita
Kiyoshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001323:Autoantibodies / Q000032:analysis / Q000097:blood*; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology; D011182:Postoperative Care / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000276:immunology* / Q000503:physiopathology
D001323:Autoantibodies; D015415:Biomarkers; D010978:Platelet Factor 4; D006493:Heparin