Abstract
BackgroundAntibodies to the heparin-platelet factor-4 (HPF-4) complex (HIT antibodies) have been observed in patients with heparin-induced thrombocytopenia (HIT). These antibodies are thought to be involved in thrombosis through activation of platelet/endothelial cells. This prospective study was conducted to determine the incidence of post-operative HIT antibodies to assess the associated risk of deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).MethodsWe studied 104 patients who underwent unilateral primary TKA (n = 44) and primary THA (n = 60) with short-duration prophylaxis (1–2 days of a fixed dose of unfractionated heparin). HIT antibodies were assayed using a sandwich-type ELISA before the operation and after heparin treatment (post-operative day 7).ResultsIn the clinical outcome, the incidence of symptomatic DVT was 15.4% (16/104, TKA; 10, THA 6) and pulmonary embolism (PE) was not observed. The total seroconversion rate of HIT antibodies at post-operative day 7 was 34.6% (36/104). Among 36 seroconverted patients, 11 (30.6%) developed symptomatic DVT and 5 out of 68 of the non-seroconverted patients (7.4%) developed symptomatic DVT. The incidence for DVT was significantly higher in the seroconverted patients compared with that of the non-seroconverted patients (odds ratio 5.5, 95%CI: 1.7–17.6 p = 0.0028). Furthermore, in the patients with symptomatic DVT, the titer of HIT antibodies at post-operative day 7 was significantly higher compared with those without symptomatic DVT.ConclusionOur data therefore suggest that seroconversion for HIT antibodies generated by heparin is associated with a risk of DVT in patients undergoing total joint replacement.
Highlights
Antibodies to the heparin-platelet factor-4 (HPF-4) complex (HIT antibodies) have been observed in patients with heparin-induced thrombocytopenia (HIT)
In patients undergoing total joint replacement in the absence of any prophylaxis, the incidence of venographydetected deep vein thrombosis (DVT) ranges from 42% to 57% in total hip arthroplasty (THA) and 41% to 85% in total knee arthroplasty (TKA) [4], while that of clinically overt pulmonary embolism (PE) ranges between 0.1% and 1.0% [5]
We evaluated the levels of HIT antibodies in patients undergoing THA or TKA under unfractionated heparin (UFH) prophylaxis in relation to the DVT risk
Summary
Antibodies to the heparin-platelet factor-4 (HPF-4) complex (HIT antibodies) have been observed in patients with heparin-induced thrombocytopenia (HIT). These antibodies are thought to be involved in thrombosis through activation of platelet/endothelial cells. This prospective study was conducted to determine the incidence of post-operative HIT antibodies to assess the associated risk of deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery [1]. In patients undergoing total joint replacement in the absence of any prophylaxis, the incidence of venographydetected DVT ranges from 42% to 57% in THA and 41% to 85% in TKA [4], while that of clinically overt PE ranges between 0.1% and 1.0% [5]
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