Francis John L, Drexler Alane, Duncan Mary Kathryn, Walker Jamie M, Hursting Marcie J, Levine Robert L
Florida Hospital Institute of Translational Research, Orlando, FL 32804, USA.
Am J Emerg Med. 2007 Mar;25(3):279-84. doi: 10.1016/j.ajem.2006.07.015.
Patients with heparin-platelet factor 4 (PF4) antibodies, particularly platelet-activating ones, are at risk for heparin-induced thrombocytopenia if administered heparin. We determined the heparin-PF4 antibody prevalence in emergency department (ED) patients presenting with chest pain or symptoms of thrombosis.
Admission samples from 324 ED patients with chest pain or symptoms of thrombosis were tested for heparin-PF4 antibodies and, if positive, platelet-activating antibodies.
Twenty-four (7.4%; 95% confidence interval, 4.8%-10.8%) patients had heparin-PF4 antibodies. Seropositivity occurred in 18 (9.2%) of 196 patients recently (< or =6 months) hospitalized vs 6 (4.7%) of 128 not recently hospitalized (P = .19), and in 16/231 (6.9%) patients with chest pain vs 8/93 (8.6%) with other thrombosis (P = .64). Of 22 seropositive patients retested, 8 (7 recently hospitalized) had platelet-activating antibodies.
Heparin-PF4 antibody prevalence is 7.4% in ED patients with chest pain or thrombosis, with approximately 1 in 3 seropositive patients having platelet-activating antibodies. Alternative, nonheparin anticoagulation would be prudent in these at-risk patients.
患有肝素 - 血小板第4因子（PF4）抗体的患者，尤其是那些能激活血小板的抗体患者，如果使用肝素，有发生肝素诱导的血小板减少症的风险。我们确定了急诊科（ED）中出现胸痛或血栓形成症状的患者中肝素 - PF4抗体的患病率。
对324例出现胸痛或血栓形成症状的急诊科患者的入院样本进行肝素 - PF4抗体检测，若呈阳性，则检测血小板激活抗体。
24例（7.4%；95%置信区间，4.8% - 10.8%）患者有肝素 - PF4抗体。196例近期（≤6个月）住院患者中有18例（9.2%）血清阳性，而128例近期未住院患者中有6例（4.7%）血清阳性（P = 0.19）；胸痛患者中16/231例（6.9%）血清阳性，其他血栓形成患者中8/93例（8.6%）血清阳性（P = 0.64）。在重新检测的22例血清阳性患者中，8例（7例近期住院）有血小板激活抗体。
急诊科有胸痛或血栓形成症状的患者中肝素 - PF4抗体患病率为7.4%，约三分之一血清阳性患者有血小板激活抗体。对于这些高危患者，谨慎选择非肝素抗凝剂是明智的。
