title: Elevated heparin-induced antibodies are more common in diabetic patients with vascular disease.
abstract: Background. Hypercoagulable disorders can lead to deep vein thrombosis (DVT), arterial thrombosis or embolization, and early or recurrent bypass graft failure. The purpose of this study was to identify whether diabetes increased the likelihood of heparin-induced platelet factor 4 antibodies in at risk vascular patients. Methods. We reviewed clinical data on 300 consecutive patients. A hypercoagulable workup was performed if patients presented with (1) early bypass/graft thrombosis (<30 days), (2) multiple bypass/graft thrombosis, and (3) a history of DVT, pulmonary embolus (PE), or native vessel thrombosis. Relevant clinical variables were analyzed and compared between patients with diabetes (DM) and without diabetes (nDM). Results. 85 patients (47 women; age 53 ± 16 years, range 16-82 years) had one of the defined conditions and underwent a hypercoagulable evaluation. Screening was done in 4.7% of patients with early bypass graft thrombosis, 60% of patients were screened because of multiple bypass or graft thrombosis, and 35.3% had a previous history of DVT, PE, or native vessel thrombosis. Of the 43 patients with DM and 42 nDM evaluated, 59 patients (69%) had an abnormal hypercoagulable profile. An elevated heparin antibody level was present in 30% of DM and 12% of nDM patients (chi-squared test P < 0.04). Additionally, DM was associated with a higher likelihood of arterial complications while nDM was associated with a higher rate of venous adverse events (chi-squared test P < 0.003). Conclusions. Diabetes is associated with a higher likelihood of developing heparin-induced antibodies and an increased combined incidence of arterial complications that include early or multiple bypass/graft thrombosis. This finding may influence the choice of anticoagulation in diabetic patients at risk with vascular disease.
authors.affiliation: Lebanese American University and University Medical Center Rizk Hospital, P.O. Box 11-3288, Zahar Street, Achrafieh, Beirut, Lebanon ; Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Naoum
authors.affiliation: Lebanese American University and University Medical Center Rizk Hospital, P.O. Box 11-3288, Zahar Street, Achrafieh, Beirut, Lebanon.
authors.forename: Nibal R
authors.initials: NR
authors.lastname: Chamoun
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Mitul S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Tiffany K
authors.initials: TK
authors.lastname: Street
authors.affiliation: Lebanese American University and University Medical Center Rizk Hospital, P.O. Box 11-3288, Zahar Street, Achrafieh, Beirut, Lebanon.
authors.forename: Mazen
authors.initials: M
authors.lastname: Haydar
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Bismuth
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El-Sayed
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
authors.affiliation: Houston Methodist and DeBakey Heart and Vascular Center, Houston, TX, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden