A. Koster et al., Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices, J THOR SURG, 121(2), 2001, pp. 331-335
Citations number
15
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: Coating of ventricular assist devices (VADs) with heparin improv
es the biocompatibility and may reduce the need for systemic anticoagulatio
n. However, heparins are associated with the risk of formation of heparin/p
latelet factor 4 antibodies (HPF4/A) and the development of heparin-associa
ted 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-sev
en received a heparin-coated (group 1) and 43 a noncoated (group 2) VAD. HP
F4/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 aft
er termination of systemic heparinization. In group 1 there was no signific
ant difference in the incidence of recurrent pump thromboses in patients wh
o 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 H
PF/A but no thromboembolism. However, all 22 patients who had thromboemboli
sm had HPF4/A.
Conclusions: Heparin coating of the VAD surface does not enhance the occurr
ence of HPF4/A-associated immunologic or thrombogenic reactions. However, t
he presence of these antibodies is strongly associated with an increased ri
sk of thromboembolism in patients with a VAD.