Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery

T. J. Gluckman, J. B. Segal, S. P. Schulman, E. P. Shapiro, T. S. Kickler, M. M. Prechel, John Conte, J. M. Walenga, I. Shafique, Jeffrey J. Rade

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Abstract

Background: Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. Objectives: To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. Patients/Methods: Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6weeks and 6months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. Results: Six weeks after surgery, 52% of patients were anti-PF4/heparin seropositive and 9% were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19% vs. 20%, P = NS), the percentage of patients with an occluded SVG (33% vs. 33%;, P = NS) nor the incidence of adverse clinical events (21% vs. 24%, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. Conclusion: Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery.

Original languageEnglish (US)
Pages (from-to)1457-1464
Number of pages8
JournalJournal of Thrombosis and Haemostasis
Volume7
Issue number9
DOIs
StatePublished - Sep 2 2009

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Platelet Factor 4
Saphenous Vein
Coronary Artery Bypass
Heparin
Transplants
Antibodies
Thrombocytopenia
Serotonin
Multidetector Computed Tomography
Platelet Activation
Coronary Angiography
Immunoglobulin G

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Gluckman, T. J. ; Segal, J. B. ; Schulman, S. P. ; Shapiro, E. P. ; Kickler, T. S. ; Prechel, M. M. ; Conte, John ; Walenga, J. M. ; Shafique, I. ; Rade, Jeffrey J. / Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery. In: Journal of Thrombosis and Haemostasis. 2009 ; Vol. 7, No. 9. pp. 1457-1464.
@article{e265883e1906479c93510d403c9a2808,
title = "Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery",
abstract = "Background: Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. Objectives: To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. Patients/Methods: Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6weeks and 6months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. Results: Six weeks after surgery, 52{\%} of patients were anti-PF4/heparin seropositive and 9{\%} were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19{\%} vs. 20{\%}, P = NS), the percentage of patients with an occluded SVG (33{\%} vs. 33{\%};, P = NS) nor the incidence of adverse clinical events (21{\%} vs. 24{\%}, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. Conclusion: Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery.",
author = "Gluckman, {T. J.} and Segal, {J. B.} and Schulman, {S. P.} and Shapiro, {E. P.} and Kickler, {T. S.} and Prechel, {M. M.} and John Conte and Walenga, {J. M.} and I. Shafique and Rade, {Jeffrey J.}",
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Gluckman, TJ, Segal, JB, Schulman, SP, Shapiro, EP, Kickler, TS, Prechel, MM, Conte, J, Walenga, JM, Shafique, I & Rade, JJ 2009, 'Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery', Journal of Thrombosis and Haemostasis, vol. 7, no. 9, pp. 1457-1464. https://doi.org/10.1111/j.1538-7836.2009.03526.x

Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery. / Gluckman, T. J.; Segal, J. B.; Schulman, S. P.; Shapiro, E. P.; Kickler, T. S.; Prechel, M. M.; Conte, John; Walenga, J. M.; Shafique, I.; Rade, Jeffrey J.

In: Journal of Thrombosis and Haemostasis, Vol. 7, No. 9, 02.09.2009, p. 1457-1464.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery

AU - Gluckman, T. J.

AU - Segal, J. B.

AU - Schulman, S. P.

AU - Shapiro, E. P.

AU - Kickler, T. S.

AU - Prechel, M. M.

AU - Conte, John

AU - Walenga, J. M.

AU - Shafique, I.

AU - Rade, Jeffrey J.

PY - 2009/9/2

Y1 - 2009/9/2

N2 - Background: Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. Objectives: To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. Patients/Methods: Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6weeks and 6months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. Results: Six weeks after surgery, 52% of patients were anti-PF4/heparin seropositive and 9% were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19% vs. 20%, P = NS), the percentage of patients with an occluded SVG (33% vs. 33%;, P = NS) nor the incidence of adverse clinical events (21% vs. 24%, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. Conclusion: Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery.

AB - Background: Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. Objectives: To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. Patients/Methods: Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6weeks and 6months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. Results: Six weeks after surgery, 52% of patients were anti-PF4/heparin seropositive and 9% were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19% vs. 20%, P = NS), the percentage of patients with an occluded SVG (33% vs. 33%;, P = NS) nor the incidence of adverse clinical events (21% vs. 24%, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. Conclusion: Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery.

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DO - 10.1111/j.1538-7836.2009.03526.x

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JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

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