title: The clinical significance and risk factors of anti-platelet factor 4/heparin antibody on maintenance hemodialysis patients: a two-year prospective follow-up.
abstract: BACKGROUND
  Heparin-induced thrombocytopenia is an immune response mediated by anti-PF4/heparin antibody, which is clinically characterized by thrombocytopenia and thromboembolic events. In this study, a prospective and multi-center clinical investigation 1) determined the positive rate of anti-PF4/heparin antibody in maintenance hemodialysis patients in China, 2) identified the related risk factors, and 3) further explored the effect of the anti-PF4/heparin antibody on bleeding, thromboembolic events, and risk of death in the patients.
  
  
  METHODS
  The serum anti-PF4/heparin antibody was measured in 661 patients from nine hemodialysis centers, detected by IgG-specific ELISA and followed by confirmation with excess heparin. Risk factors of these patients were analyzed. Based on a two-year follow-up, the association between the anti-PF4/heparin antibody and bleeding, thromboembolic events, and risk of death in the patients was investigated.
  
  
  RESULTS
  1) The positivity rate of the anti-PF4/heparin antibody in maintenance hemodialysis patients was 5.6%. With diabetes as an independent risk factor, the positivity rate of the anti-PF4/heparin antibody decreased in the patients undergoing weekly dialyses ≥3 times. 2) The positivity rate of the anti-PF4/heparin antibody was not related to the occurrence of clinical thromboembolic events and was not a risk factor for death within two years in maintenance hemodialysis patients. 3) Negativity for the anti-PF4/heparin antibody combined with a reduction of the platelet count or combined with the administration of antiplatelet drugs yielded a significant increase in bleeding events. However, the composite determination of the anti-PF4/heparin antibody and thrombocytopenia, as well as the administration of antiplatelet drugs, was not predictive for the risk of thromboembolic events in the maintenance hemodialysis patients.
  
  
  CONCLUSIONS
  A single detection of the anti-PF4/heparin antibody did not predict the occurrence of clinical bleeding, thromboembolic events, or risk of death in the maintenance hemodialysis patients.
authors: Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease-2011DAV00088, Beijing, China.
authors: Delong
authors: D
authors: Zhao
authors: Xuefeng
authors: X
authors: Sun
authors: Li
authors: L
authors: Yao
authors: Hongli
authors: H
authors: Lin
authors: Jijun
authors: J
authors: Li
authors: Jiuyang
authors: J
authors: Zhao
authors: Zhimin
authors: Z
authors: Zhang
authors: Lide
authors: L
authors: Lun
authors: Jianrong
authors: J
authors: Zhang
authors: Mingxu
authors: M
authors: Li
authors: Qi
authors: Q
authors: Huang
authors: Yang
authors: Y
authors: Yang
authors: Shimin
authors: S
authors: Jiang
authors: Yong
authors: Y
authors: Wang
authors: Hanyu
authors: H
authors: Zhu
authors: Xiangmei
authors: X
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000009:adverse effects* / Q000097:blood / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006493:Heparin / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality
chemical_list: D000906:Antibodies; D010978:Platelet Factor 4; D006493:Heparin
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