title: Production of Anti-platelet Factor 4/Heparin Complex Antibodies After Cardiovascular Surgery.
abstract: To study the production of anti-platelet factor 4 (anti-PF4)/heparin complex antibodies of Ig (immunoglobulin) G/IgA/IgM using enzyme-linked immunosorbent assay (ELISA; heparin-induced thrombocytopenia [HIT] antibodies) in 79 patients undergoing cardiovascular surgery, we employed Δoptical density (OD) as a marker of HIT-antibody production. The ΔODs were calculated from the differences in the ODs using ELISA. Patient were classified into 3 ΔOD ranges: ΔOD ≥ 1.0, ΔOD ≥ 0.4 to <1.0, and ΔOD < 0.4. The underlying disease, time course of the postoperative platelet count, D-dimer level, postoperative brain magnetic resonance imaging (MRI), use of cardiopulmonary bypass and postoperative thrombocytosis were not considered for the 3 ΔOD classifications. None of the 6 patients with ΔOD ≥ 1 .0 and a positive functional assay was diagnosed with HIT due to the absence of HIT-derived thrombocytopenia. In conclusion, HIT-antibody production increased until day 7 after heparin cessation and reached a trace level on day 14. It was demonstrated that HIT-antibody production is in remission unless there is any evidence of a further increase during the second week postsurgery.
authors.affiliation: Internal Medicine, Hyogo Prefectural Awaji Hospital, Sumoto, Japan tak-matsuo@deluxe.ocn.ne.jp.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Matsuo
authors.affiliation: Cardiovascular Surgery, Yamanashi University Hospital, Chuo, Yamanashi, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Motohashi
authors.affiliation: Kobe Research Projects on Thrombosis and Haemostasis, Kobe, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Wanaka
authors.affiliation: Cardiovascular Institute, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Walenga
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010978:Platelet Factor 4; D011183:Postoperative Complications / Q000097:blood* / Q000000981:diagnostic imaging; D011859:Radiography; D013921:Thrombocytopenia / Q000097:blood* / Q000139:chemically induced / Q000000981:diagnostic imaging
chemical_list: D001323:Autoantibodies; D010978:Platelet Factor 4; D006493:Heparin
keywords: anti-PF4/heparin complex antibodies; cardiovascular surgery; heparin-induced thrombocytopenia; reactive thrombocytosis