Document Detail


Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices.
MedLine Citation:
PMID:  11174739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Coating of ventricular assist devices (VADs) with heparin improves the biocompatibility and may reduce the need for systemic anticoagulation. However, heparins are associated with the risk of formation of heparin/platelet factor 4 antibodies (HPF4/A) and the development of heparin-associated thromboemboli. We analyzed the occurrence of HPF4/A and thromboembolism in patients with heparin-coated and noncoated VADs. METHODS: One hundred patients were enrolled in the investigation. Fifty-seven received a heparin-coated (group 1) and 43 a noncoated (group 2) VAD. HPF4/A testing was performed before and 2 and 12 weeks after implantation by the heparin platelet factor 4 enzyme-linked immunosorbent assay. RESULTS: There was no significant difference in the occurrence of HPF4/A in the 2 groups (P =.102). Before the operation, 21 of the patients in group 1 had positive test responses and 25 in group 2. No patient had HPF4/A after termination of systemic heparinization. In group 1 there was no significant difference in the incidence of recurrent pump thromboses in patients who had positive test responses for HPF4/A (n = 11) when compared with those who had negative test responses (n = 9, P =.89). Twenty-one patients had HPF/A but no thromboembolism. However, all 22 patients who had thromboembolism had HPF4/A. CONCLUSIONS: Heparin coating of the VAD surface does not enhance the occurrence of HPF4/A-associated immunologic or thrombogenic reactions. However, the presence of these antibodies is strongly associated with an increased risk of thromboembolism in patients with a VAD.
Authors:
A Koster; M Loebe; R Sodian; E V Potapov; R Hansen; J Müller; F Mertzlufft; G J Crystal; H Kuppe; R Hetzer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  121     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-22     Completed Date:  2001-03-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Deutsches Herzzentrum Berlin, Augustenberger Platz 1, D-13353 Berlin, Germany. koster@dhzb.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anticoagulants / administration & dosage,  immunology*
Female
Fibrinolytic Agents / administration & dosage,  immunology*
Heart-Assist Devices* / adverse effects
Heparin / administration & dosage,  immunology*
Humans
Male
Middle Aged
Platelet Factor 4 / immunology*
Thromboembolism / etiology*,  immunology
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 37270-94-3/Platelet Factor 4; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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