Author(s): Lubenow N, Hinz P, Thomaschewski S, Lietz T, Vogler M,
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Abstract Heparin can induce heparin-induced thrombocytopenia (HIT). The combined effect of type of surgery (major vs minor) and heparin on this prothrombotic immune reaction to platelet factor 4 (PF4)/heparin was analyzed. In a randomized, double-blind study, trauma patients receiving low-molecular-weight (LMWH) or unfractionated heparin (UFH) for thrombosis prophylaxis were assessed for PF4/heparin-antibody seroconversion, HIT, and thrombosis according to type of surgery. The risk for seroconversion was higher than major versus minor surgery odds ratio, 7.98 [95\% confidence interval, 2.06-31.00], P = .003, controlled for potential confounders, as was the risk for HIT (2.2\% [95\% confidence interval, 0.3\%-4.1\%] vs 0.0\%, P = .010). During LMWH compared with UFH thromboprophylaxis, HIT (1 of 298 vs 4 of 316; P = .370) and PF4/heparin seroconversion (1.7\% vs 6.6\%; P = .002) were less frequent, driven by differences in patients undergoing major surgery (incidence of HIT: LMWH 0.8\% vs UFH 4.0\%; P = .180; seroconversion rates: 4.0\% vs 17.0\%; P = .001). After minor surgery, no case of HIT occurred. The severity of trauma and the need for major surgery strongly influence the risk of an anti-PF4/heparin immune response, which is then increased by UFH. In major trauma certoparin may be safer than UFH because it induces HIT-antibody seroconversion, and the corresponding risk of HIT, less frequently.
This article was published in Blood
and referenced in Journal of Blood Disorders & Transfusion