Population Health Research Institute, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada.
Thromb Haemost. 2012 Jan;107(1):8-14. doi: 10.1160/TH11-07-0480. Epub 2011 Nov 10.
It was the objective of this study to obtain best estimates of the prevalence of anti-PF4/heparin antibodies in patients not suspected to have clinical heparin-induced thrombocytopenia (HIT) prior to undergoing cardiac surgery and to determine whether preoperative antibody status and antibody class is predictive of postoperative thromboembolic outcomes, non-thromboembolic outcomes, length of stay, and mortality. PubMed and EMBASE online databases were searched up to July 2011, and we included studies involving adults undergoing cardiac surgery examining the relationship between preoperative anti-PF4/heparin antibodies (ELISA) and postoperative clinical outcomes. Five studies involving a combined total of 2,332 patients met our inclusion criteria. Preoperative anti-PF4/heparin antibodies were detected in 5-22% of patients. No study demonstrated an association between preoperative anti-PF4/heparin antibodies and postoperative thromboembolic outcomes or mortality. Three studies demonstrated a statistically significant association between preoperative anti-PF4/heparin antibodies and length of stay while two showed an association with non-thromboembolic complications. In the one study that examined outcomes by anti-PF4/heparin antibody class, IgM antibodies predicted non-thromboembolic complications and length-of-stay. None of the studies reported prior heparin exposure, and most studies did not examine the relationship of the absolute value of antibody titres (ELISA OD) and risk, nor the incidence of true/clinical HIT in preoperative positive or negative patients. In conclusion, pre-formed anti-PF4/heparin antibodies are common in patients undergoing cardiac surgery, but the available literature does not support that they predict postoperative thromboembolic complications or death. There does appear to be an association between anti-PF4/heparin antibodies and non-thromboembolic adverse events, but a causal relationship is unlikely.
本研究旨在获得在接受心脏手术前未怀疑患有临床肝素诱导血小板减少症（HIT）的患者中抗 PF4/肝素抗体的流行率的最佳估计，并确定术前抗体状态和抗体类别是否可预测术后血栓栓塞结局、非血栓栓塞结局、住院时间和死亡率。检索了 PubMed 和 EMBASE 在线数据库，截至 2011 年 7 月，我们纳入了涉及检查术前抗 PF4/肝素抗体（ELISA）与术后临床结局之间关系的成年人心脏手术的研究。五项研究共纳入了 2332 例患者，符合我们的纳入标准。术前抗 PF4/肝素抗体在 5-22%的患者中被检测到。没有研究表明术前抗 PF4/肝素抗体与术后血栓栓塞结局或死亡率之间存在关联。三项研究表明术前抗 PF4/肝素抗体与住院时间之间存在统计学显著关联，而两项研究表明与非血栓栓塞并发症之间存在关联。在一项研究中，根据抗 PF4/肝素抗体类别检查了结局，IgM 抗体预测了非血栓栓塞并发症和住院时间。没有一项研究报告了术前肝素暴露情况，并且大多数研究没有检查抗体效价绝对值（ELISA OD）与风险的关系，也没有检查术前阳性或阴性患者中真正/临床 HIT 的发生率。总之，在接受心脏手术的患者中，预先形成的抗 PF4/肝素抗体很常见，但现有文献不支持它们预测术后血栓栓塞并发症或死亡。抗 PF4/肝素抗体与非血栓栓塞不良事件之间似乎存在关联，但不太可能存在因果关系。
