Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices

Andreas Koster, Matthias Loebe, Ralf Sodian, Evgenij V. Potapov, Roland Hansen, Johannes Müller, Fritz Mertzlufft, George J. Crystal, Herrmann Kuppe, Roland Hetzer

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)331-335
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume121
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

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Heart-Assist Devices
Thromboembolism
Heparin
Platelet Factor 4
Antibodies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices. / Koster, Andreas; Loebe, Matthias; Sodian, Ralf; Potapov, Evgenij V.; Hansen, Roland; Müller, Johannes; Mertzlufft, Fritz; Crystal, George J.; Kuppe, Herrmann; Hetzer, Roland.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 121, No. 2, 2001, p. 331-335.

Research output: Contribution to journalArticle

Koster, A, Loebe, M, Sodian, R, Potapov, EV, Hansen, R, Müller, J, Mertzlufft, F, Crystal, GJ, Kuppe, H & Hetzer, R 2001, 'Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices', Journal of Thoracic and Cardiovascular Surgery, vol. 121, no. 2, pp. 331-335. https://doi.org/10.1067/mtc.2001.111655
Koster, Andreas ; Loebe, Matthias ; Sodian, Ralf ; Potapov, Evgenij V. ; Hansen, Roland ; Müller, Johannes ; Mertzlufft, Fritz ; Crystal, George J. ; Kuppe, Herrmann ; Hetzer, Roland. / Heparin antibodies and thromboembolism in heparin-coated and noncoated ventricular assist devices. In: Journal of Thoracic and Cardiovascular Surgery. 2001 ; Vol. 121, No. 2. pp. 331-335.
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abstract = "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.",
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AU - Koster, Andreas

AU - Loebe, Matthias

AU - Sodian, Ralf

AU - Potapov, Evgenij V.

AU - Hansen, Roland

AU - Müller, Johannes

AU - Mertzlufft, Fritz

AU - Crystal, George J.

AU - Kuppe, Herrmann

AU - Hetzer, Roland

PY - 2001

Y1 - 2001

N2 - 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.

AB - 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.

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