IgG-class anti-PF4/heparin antibodies and symptomatic DVT in orthopedic surgery patients receiving different anti-thromboembolic prophylaxis therapeutics.
BACKGROUND
Heparin-induced thrombocytopenia (HIT) is a thromboembolic complication that can occur with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Our objective was to determine and compare the incidence of IgG-class HIT antibodies in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) with different antithrombotic prophylaxis therapies and their contributions to the occurrence of venous thromboembolism (VTE).


METHODS
A prospective observational study was performed for 374 Japanese patients undergoing THA or TKA to determine the incidence of VTE. IgG-class anti-PF4/heparin antibodies were measured using IgG-specific EIA before and after the operation.


RESULTS
In the clinical outcome, the incidence of symptomatic deep vein thrombosis (DVT) was 15.0% (56/374, TKA; 35, THA; 21) and pulmonary emboli (PE) were not observed. The total seroconversion incidence of IgG-class PF4/heparin antibodies was 19.8% (74/374). The seroconversion incidence of IgG-class PF4/heparin antibodies was higher in patients receiving UFH (32.7%) compared to those receiving LMWH (9.5%) or fondaparinux (14.8%). Furthermore, the seroconversion incidence was significantly higher in patients undergoing TKA compared to those undergoing THA. Based on multivariate analysis, seroconversion of the IgG-class PF4/heparin antibodies was independent a risk factor for symptomatic DVT.


CONCLUSIONS
Our findings show that the seroconversion of IgG-class anti-PF4/heparin antibodies differed with various anti-thrombotic prophylaxis therapeutics and was associated with the risk of DVT in a subset of patients undergoing total joint arthroplasty (TKA and THA).
Department of Orthopedics Surgery and Department of Rheumatology, NHO Nagasaki Medical Center, Japan.
Satoru
S
Motokawa
Takafumi
T
Torigoshi
Yumi
Y
Maeda
Kazushige
K
Maeda
Yuka
Y
Jiuchi
Takayuki
T
Yamaguchi
Shinsuke
S
Someya
Hiroyuki
H
Shindo
Kiyoshi
K
Migita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000096:biosynthesis* / Q000097:blood / Q000145:classification; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000097:blood / Q000145:classification*; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000009:adverse effects / Q000276:immunology*; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*
D001323:Autoantibodies; D007074:Immunoglobulin G; D010978:Platelet Factor 4; D006493:Heparin
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