The severity of trauma determines the immune response to PF4/heparin and the frequency of heparin-induced thrombocytopenia.
Heparin can induce heparin-induced thrombocytopenia (HIT). The combined effect of type of surgery (major vs minor) and heparin on this prothrombotic immune reaction to platelet factor 4 (PF4)/heparin was analyzed. In a randomized, double-blind study, trauma patients receiving low-molecular-weight (LMWH) or unfractionated heparin (UFH) for thrombosis prophylaxis were assessed for PF4/heparin-antibody seroconversion, HIT, and thrombosis according to type of surgery. The risk for seroconversion was higher than major versus minor surgery odds ratio, 7.98 [95% confidence interval, 2.06-31.00], P = .003, controlled for potential confounders, as was the risk for HIT (2.2% [95% confidence interval, 0.3%-4.1%] vs 0.0%, P = .010). During LMWH compared with UFH thromboprophylaxis, HIT (1 of 298 vs 4 of 316; P = .370) and PF4/heparin seroconversion (1.7% vs 6.6%; P = .002) were less frequent, driven by differences in patients undergoing major surgery (incidence of HIT: LMWH 0.8% vs UFH 4.0%; P = .180; seroconversion rates: 4.0% vs 17.0%; P = .001). After minor surgery, no case of HIT occurred. The severity of trauma and the need for major surgery strongly influence the risk of an anti-PF4/heparin immune response, which is then increased by UFH. In major trauma certoparin may be safer than UFH because it induces HIT-antibody seroconversion, and the corresponding risk of HIT, less frequently.
Lubenow
Norbert
N
Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald.
Hinz
Peter
P
Thomaschewski
Simone
S
Lietz
Theresia
T
Vogler
Michael
M
Ladwig
Andrea
A
Jünger
Michael
M
Nauck
Matthias
M
Schellong
Sebastian
S
Wander
Kathrin
K
Engel
Georg
G
Ekkernkamp
Axel
A
Greinacher
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000276:immunology; D004311:Double-Blind Method; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology; D013927:Thrombosis / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D055815:Young Adult
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010978:Platelet Factor 4; D006493:Heparin