Rapid determination of anti-heparin/platelet factor 4 antibody titers in the diagnosis of heparin-induced thrombocytopenia.

Détails

ID Serval
serval:BIB_8DA349A02A19
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Rapid determination of anti-heparin/platelet factor 4 antibody titers in the diagnosis of heparin-induced thrombocytopenia.
Périodique
American Journal of Medicine
Auteur(s)
Alberio L., Kimmerle S., Baumann A., Taleghani B.M., Biasiutti F.D., Lämmle B.
ISSN
0002-9343 (Print)
ISSN-L
0002-9343
Statut éditorial
Publié
Date de publication
2003
Peer-reviewed
Oui
Volume
114
Numéro
7
Pages
528-536
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
PURPOSE: Heparin-induced thrombocytopenia is mediated by antibodies directed against the heparin-platelet factor 4 (heparin/PF4) complex. Our aim was to investigate whether rapid measurement of anti-heparin/PF4 antibodies could improve the diagnostic workup of patients with suspected heparin-induced thrombocytopenia.
METHODS: We examined 148 consecutive patients in our laboratory between January 1995 and June 2001 for suspected heparin-induced thrombocytopenia. Clinical data allowed retrospective assessment of the likelihood of heparin-induced thrombocytopenia. Antibodies against the heparin/PF4 complex were detected by a rapid particle gel immunoassay.
RESULTS: Anti-heparin/PF4 antibodies were detected in 69 (47%) of the 148 patients, at dilution titers from 1 to 256. Clinically "likely" or "very likely" heparin-induced thrombocytopenia was significantly more common in patients with titers >or=4 (95% [39/41]) than in those with undetectable antibodies (13% [9/70]; P <0.0001), a titer of 1 (18% [4/22]; P <0.0001), or a titer of 2 (33% [2/6]; P = 0.001). All 19 samples with a positive platelet aggregation test had anti-heparin/PF4 antibody titers of at least 4, including 15 samples with titers >or=32. Thromboembolic complications in heparin-treated patients were significantly more prevalent in patients with titers >or=4 (63% [26/41]) than in those with undetectable antibodies (8% [6/79]; P <0.0001) or a titer of 1 (9% [2/22]; P <0.0001). Of the 11 patients with a titer of 1 who were maintained on heparin, none developed worse thrombocytopenia or thromboembolic complications.
CONCLUSION: Anti-heparin/PF4 antibody titers, which can be measured rapidly and reproducibly using a particle gel immunoassay, can be used as a confirmatory test to complement a clinical likelihood score among patients with suspected heparin-induced thrombocytopenia.
Mots-clé
Adult, Aged, Aged, 80 and over, Antibodies/blood, Antibodies/immunology, Anticoagulants/adverse effects, Anticoagulants/blood, Coagulants/blood, Coagulants/immunology, Female, Heparin/adverse effects, Heparin/blood, Humans, Immunoassay, Male, Middle Aged, Platelet Factor 4/analysis, Platelet Factor 4/immunology, Predictive Value of Tests, Retrospective Studies, Thrombocytopenia/blood, Thrombocytopenia/chemically induced, Time Factors
Pubmed
Web of science
Création de la notice
10/02/2015 12:03
Dernière modification de la notice
20/08/2019 15:51
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