Vol. 14 No. 1 (2022): Archives of Public Health
Clinical Science

Presence of anti-TF4/heparin antibodies in patients preoperatively treated with enoxaparine after orthopedic surgery

OnlineFirst pdf 84-90
  • Natali Jordanovska-Guceva,
  • Andrijan Kartalov,
  • Biljana Kuzmanovska,
  • Milan Samardziski,
  • Filip Gucev
Natali Jordanovska-Guceva
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation and Intensive Care; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Andrijan Kartalov
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation and Intensive Care; Ss Cyril and Methodius in Skopje, Faculty of Medicine, Republic of North Macedonia
Biljana Kuzmanovska
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation and Intensive Care; Ss Cyril and Methodius in Skopje, Faculty of Medicine, Republic of North Macedonia
Milan Samardziski
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation and Intensive Care; Ss Cyril and Methodius in Skopje, Faculty of Medicine, Republic of North Macedonia
Filip Gucev
University Clinic for reumathology; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine , Republic of North Macedonia
DOI: https://doi.org/10.3889/aph.2022.6018

Published 2022-06-23

Keywords

  • heparin-induced thrombocytopenia,
  • anti-PF4/heparin antibodies,
  • total knee or hip arthroplasty,
  • enoxaparine,
  • postoperative risk

How to Cite

1.
Jordanovska-Guceva N, Kartalov A, Kuzmanovska B, Samardziski M, Gucev F. Presence of anti-TF4/heparin antibodies in patients preoperatively treated with enoxaparine after orthopedic surgery. Arch Pub Health [Internet]. 2022 Jun. 23 [cited 2024 Nov. 5];14(1). Available from: https://id-press.eu/aph/article/view/6018

Copyright (c) 2021 Natali Jordanovska-Guceva, Andrijan Kartalov, Biljana Kuzmanovska, Milan Samardziski, Filip Gucev

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Heparin-induced thrombocytopenia (HIT) is a condition caused by antibodies against the platelet factor 4 (PF4)/heparin complex. This significantly increases the risk of bleeding and thrombosis in patients, which is essential in the postoperative period. In this study we examined the rate of seroconversion of anti-PF4/heparin antibodies in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after total knee or hip arthroplasty. The aims of the study were to assess the risk of HIT by evaluation of induction of anti-PF4/heparin antibodies in patients with RA and OA after total knee or hip arthroplasty, treated prophylactically with enoxaparine. Material and methods: We followed 36 patients aged 18 to 80 years, after total knee or hip arthroplasty, treated prophylactically with enoxaparine. Patients were divided in two groups: patients with RA and patients with OA.  They were examined for occurrence of HIT. Blood was sampled twice, from a peripheral vein, for immunologic tests. The first time it was done before enoxaparine application and the second time postoperatively 10 days after surgery. We noted demographic data, anti-PF4/heparin antibodies, erythrocyte sedimentation rate (ESR), CRP, RF, antiCCP and anti-nuclear antibodies Hep2 (ANA). Results: There was no significant difference in the values of anti-PF4/heparin antibodies in patients with RA and OA preoperatively. The presence of anti-PF4/heparin antibodies was significantly lower in RA patients compared to OA (7.14% versus 27.27%, p=0.034). There was no significant association between levels of anti-PF4/heparin antibodies and ESR, CRP, RF, CCP, ANA. Conclusion: The results obtained showed a lower level of anti-PF4/heparin antibodies in patients with RA than in patients with OA. This shows that there may be a difference in the generation of this antibody in patients with RA compared to patients with OA, prophylactically treated with enoxaparine after total knee or hip arthroplasty.

OnlineFirst pdf 84-90

Downloads

Download data is not yet available.

References

  1. Arepally GM, Ortel TL. Heparin-induced thrombocytopenia. Annu Rev Med 2010;61:77–90. DOI: https://doi.org/10.1146/annurev.med.042808.171814
  2. McKenzie SE, Sachais BS. Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia. Curr Opin Hematol 2014;21:380–7. DOI: https://doi.org/10.1097/MOH.0000000000000066
  3. Walz DA, Hung GL. In vivo studies on the binding of heparin and its fractions with platelet factor 4. Semin ThrombHemost. 1985;11:40–7. DOI: https://doi.org/10.1055/s-2007-1004358
  4. Amiral J, Vissac AM. Generation and pathogenicity of anti-platelet factor 4 antibodies: diagnostic implications. Clin Appl ThrombHemost. 1999;5 Suppl 1:S28–31. DOI: https://doi.org/10.1177/10760296990050S106
  5. Newman PM, Chong BH. Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purified anti-PF4-heparin antibodies to platelets and the resultant platelet activation. Blood. 2000;96:182–7. DOI: https://doi.org/10.1182/blood.V96.1.182.013k18_182_187
  6. Padmanabhan A, Jones CG, Bougie DW, Curtis BR, McFarland JG, Wang Det, et al. Heparin-independent, PF4-dependent binding of HIT antibodies to platelets: implications for HIT pathogenesis. Blood. 2015;125:155–61. DOI: https://doi.org/10.1182/blood-2014-06-580894
  7. Satoh T, Tanaka Y, Okazaki Y, Kaburaki J, Ikeda Y, Kuwana M. Heparindependent and -independent anti-platelet factor 4 autoantibodies in patients with systemic lupus erythematosus. Rheumatology (Oxford). 2012;51:1721–8. DOI: https://doi.org/10.1093/rheumatology/kes145
  8. Warkentin TE, Cook RJ, Marder VJ, Sheppard JA, Moore JC, Eriksson BI, et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin. Blood. 2005;106:3791–6. DOI: https://doi.org/10.1182/blood-2005-05-1938
  9. Warkentin TE. Fondaparinux: does it cause HIT? Can it treat HIT? Expert Rev Hematol. 2010;3:567–81. DOI: https://doi.org/10.1586/ehm.10.54
  10. Warkentin TE, Basciano PA, Knopman J, Bernstein RA. Spontaneous heparininduced thrombocytopenia syndrome: 2 new cases and a proposal for defining this disorder. Blood. 2014;123:3651–4. DOI: https://doi.org/10.1182/blood-2014-01-549741
  11. Krauel K, Pötschke C, Weber C, Kessler W, Fürll B, Ittermann T, et al. Platelet factor 4 binds to bacteria, [corrected] inducing antibodies cross-reacting with the major antigen in heparin-induced thrombocytopenia. Blood. 2011;117:1370–8. DOI: https://doi.org/10.1182/blood-2010-08-301424
  12. Torigoshi T, Motokawa S, Maeda Y, Maeda K, Hiura T, Takayama G, et al. Clinical relevance of heparin-PF4 complex antibody in DVT after total joint replacement. BMC MusculoskeletDisord. 2009;10:42. DOI: https://doi.org/10.1186/1471-2474-10-42
  13. Mallik A, Carlson KB, DeSancho MT. A patient with “spontaneous” heparininduced thrombocytopenia and thrombosis after undergoing knee replacement. Blood Coagul Fibrinolysis. 2011;22:73–5. DOI: https://doi.org/10.1097/MBC.0b013e328340ff11
  14. Martin-Toutain I, Piette JC, Diemert MC, Faucher C, Jobic L, Ankri A. High prevalence of antibodies to platelet factor 4 heparin in patients with antiphospholipid antibodies in absence of heparin-induced thrombocytopenia. Lupus. 2007;16:79–83. DOI: https://doi.org/10.1177/0961203306075562
  15. Izumi М, Sakai Т, Shirakawa А, et al. Reduced induction of anti-PF4/heparin antibody in RA patients after total knee arthroplasty. Izumi et al. Arthritis Research & Therapy (2016) 18:191. DOI: https://doi.org/10.1186/s13075-016-1090-2
  16. Kelton JG. Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purified anti-PF4-heparin antibodies to platelets and the resultant platelet activation. Blood. 1994; 83:3232-9. DOI: https://doi.org/10.1182/blood.V83.11.3232.3232
  17. Okata T, Miyata S, Miyashita F, Maeda T, Toyoda K. Spontaneous heparininduced thrombocytopenia syndrome without any proximate heparin exposure, infection, or inflammatory condition: atypical clinical features with heparin-dependent platelet activating antibodies. Platelets. 2015;26:602–7. DOI: https://doi.org/10.3109/09537104.2014.979338
  18. Chudasama SL, Espinasse B, Hwang F, Qi R, Joglekar M, Afonina G, et al. Heparin modifies the immunogenicity of positively charged proteins. Blood. 2010;116:6046–53. DOI: https://doi.org/10.1182/blood-2010-06-292938
  19. Ohyama K, Ueki Y, Kawakami A, Kishikawa N, Tamai M, Osaki M, et al. Immune complexome analysis of serum and its application in screening for immune complex antigens in rheumatoid arthritis. Clin Chem. 2011;57:905–9. DOI: https://doi.org/10.1373/clinchem.2010.157776
  20. Brauweiler A, Merrell K, Gauld SB, Cambier JC. Cutting Edge: Acute and chronic exposure of immature B cells to antigen leads to impaired homing and SHIP1-dependent reduction in stromal cell-derived factor-1 responsiveness. J Immunol. 2007;178:3353–7. DOI: https://doi.org/10.4049/jimmunol.178.6.3353
  21. Rauava L. Immune complexome analysis of serum and its application in screening for immune complex antigens in rheumatoid arthritis. Blood. 2005; 105:131-8.
  22. Ohyama K, Kawakami A, Tamai M, Baba M, Kishikawa N, Kuroda N. Serum immune complex containing thrombospondin-1: a novel biomarker for early rheumatoid arthritis. Ann Rheum Dis. 2012;71:1916–7. DOI: https://doi.org/10.1136/annrheumdis-2012-201305

Most read articles by the same author(s)