Semin Thromb Hemost 2004; 30(3): 347-350
DOI: 10.1055/s-2004-831047
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Role of Anti-PF4/Heparin Antibodies in Recurrent Thrombotic Events after Acute Coronary Syndromes

Mary Ann Mascelli1 , Efthymios N. Deliargyris2 , Lakshmi V. Damaraju1 , Elliot S. Barnathan1 , David C. Sane2 , 3
  • 1Centocor, Malvern, Pennsylvania
  • 2Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • 3Associate Director, Clinical Pharmacology
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Publication History

Publication Date:
29 July 2004 (online)

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We postulated that patients with recent acute coronary syndromes and antibodies to the platelet factor 4/heparin complex would have an increased risk of myocardial infarction (MI), even in the absence of thrombocytopenia. We analyzed sera from patients enrolled in the placebo/unfractionated heparin arm of the GUSTO IV-ACS trial who had a high likelihood of prior heparin exposure. We selected 109 patients without thrombocytopenia with the 30-day primary endpoint (death, MI, or revascularization) and 109 age-, gender-, and race-matched controls who did not achieve the primary endpoint. Twenty-three of 218 patients (10.6%) had anti-PF4/heparin antibodies. Patients with anti-PF4/heparin were more likely to have death or MI (30.4% vs. 11.3%, p = 0.011) or MI (21.7% vs. 6.2%, p = 0.008) than patients who were negative for the antibody. Antibody-positive patients had higher levels of sVCAM-1 (892 ± 263 μg/L vs. 780 ± 228 μg/L; p = 0.04) and sICAM-1 (246 ± 50 μg/L vs. 222 ± 71 μg/L; p = 0.02) than antibody-negative patients. In a multiple logistic regression model that included inflammatory markers and clinical risk factors, antibodies to PF4/heparin were a strong predictor of 30-day MI (odds ratio, 9.0; 95% confidence intervals, 2.1 to 38.6; p < 0.01), with IL-6 being the only other predictor (odds ratio, 1.1; 95% confidence intervals, 1.0 to 1.2; p = 0.03). Antibodies to the platelet factor 4/heparin complex are a novel, independent predictor of MI at 30 days in patients presenting with acute coronary ischemic syndromes. Antibodies to PF4/heparin are a stronger predictor of MI than clinical characteristics or inflammation markers.

REFERENCES

David C SaneM.D. 

Wake Forest University School of Medicine, Section of Cardiology, Medical Center Boulevard, Winston-Salem, NC 27157-1045

Email: dsane@wfubmc.edu