ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
George J. Palmer, III
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Francis, J. L.
Right arrow Articles by Drexler, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Francis, J. L.
Right arrow Articles by Drexler, A.
Related Collections
Right arrow Extracorporeal circulation

Ann Thorac Surg 2003;75:17-22
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Comparison of bovine and porcine heparin in heparin antibody formation after cardiac surgery

John L. Francis, PhD*a, George J. Palmer, III, MDb, Rebecca Moroose, MDa, Alane Drexler, MSa

a Center for Hemostasis and Thrombosis, Orlando, Florida, USA
b Department of Thoracic Cardiovascular Surgery, Florida Hospital, Orlando, Florida, USA

* Address reprint requests to Dr Francis, Florida Hospital, Center For Hemostasis and Thrombosis, Florida Hospital Cancer Institute, 2501 N. Orange Ave, Suite 786, Orlando, FL 32804, USA
e-mail: john.francis{at}flhosp.org

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a potentially devastating complication of heparin therapy. The incidence of clinical HIT after cardiovascular surgery is less than 2%, although asymptomatic antibodies to heparin-platelet factor 4 (PF4) occur more frequently. Bovine heparin is thought to cause more HIT than porcine heparin, although this has never been established for heparin use during coronary artery bypass grafting. We therefore undertook a randomized, prospective study of heparin-PF4 antibody formation in patients undergoing first-time CABG given intraoperative bovine or porcine heparin.

METHODS: Two hundred seven patients (108 porcine, 99 bovine) completed the study. Heparin given pre- or postoperatively was always porcine. Platelet counts and heparin-PF4 antibody tests (enzyme-linked immunosorbent assays) were performed preoperatively and daily until postoperative day 7 or discharge if earlier.

RESULTS: The overall incidence of heparin-PF4 antibody formation was 42%. Six patients (2.9%) were positive preoperatively, of which, 1 developed clinical HIT. When these were excluded, seroconversion rates were 44 of 99 (44.4%) and 33 of 108 (30.6%) for bovine and porcine heparin, respectively (p = 0.041). Among patients who produced antibodies, most (90% bovine, 85% porcine) seroconverted after postoperative day 2. There were no differences in postoperative platelet counts; only 1 patient developed thrombosis associated with seroconversion, but without developing thrombocytopenia. The seroconversion rates for patients having cardiopulmonary bypass or off-pump surgery were not significantly different.

CONCLUSIONS: This study confirms the high frequency of heparin-PF4 antibodies after coronary artery bypass grafting and demonstrates a significantly higher incidence after bovine heparin. However, because some patients may seroconvert after discharge, our study may underestimate the true incidence.




This article has been cited by other articles:


Home page
 ChestHome page
E. Shantsila, G. Y. H. Lip, and B. H. Chong
Heparin-Induced Thrombocytopenia: A Contemporary Clinical Approach to Diagnosis and Management
Chest, June 1, 2009; 135(6): 1651 - 1664.
[Abstract] [Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
C. Houiste, C. Auguste, C. Macrez, S. Dereux, A. Derouet, and P. Anger
Quantitative PCR and Disaccharide Profiling to Characterize the Animal Origin of Low-Molecular-Weight Heparins
Clinical and Applied Thrombosis/Hemostasis, February 1, 2009; 15(1): 50 - 58.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. Paparella, G. Scrascia, A. Galeone, M. Coviello, G. Cappabianca, M. T. Venneri, B. Favoino, M. Quaranta, L. de Luca Tupputi Schinosa, and T. E. Warkentin
Formation of anti-platelet factor 4/heparin antibodies after cardiac surgery: influence of perioperative platelet activation, the inflammatory response, and histocompatibility leukocyte antigen status.
J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1456 - 1463.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
S. M. Begelman, S. B. Baghdasarian, I. M. Singh, M. A. Militello, M. J. Hursting, and J. R. Bartholomew
Argatroban Anticoagulation in Intensive Care Patients: Effects of Heart Failure and Multiple Organ System Failure
J Intensive Care Med, September 1, 2008; 23(5): 313 - 320.
[Abstract] [PDF]

Home page
 ChestHome page
T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff
Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 340S - 380S.
[Abstract] [Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
J. Fareed, R. L. Bick, G. Rao, S. Z. Goldhaber, A. Sasahara, H. L. Messmore, D. A. Happensteadt, and A. Nicolaides
The Immunogenic Potential of Generic Version of Low-Molecular-Weight Heparins May Not be the Same as the Branded Products
Clinical and Applied Thrombosis/Hemostasis, January 1, 2008; 14(1): 5 - 7.
[PDF]

Home page
 Card Surg AdultHome page
J. W. Hammon
Extracorporeal Circulation: Perfusion System
Card. Surg. Adult, January 1, 2008; 3(2008): 350 - 370.
[Full Text]

Home page
 Card Surg AdultHome page
S. J. Durham and J. P. Gold
Late Complications of Cardiac Surgery
Card. Surg. Adult, January 1, 2008; 3(2008): 535 - 548.
[Full Text]

Home page
 BloodHome page
S. Suvarna, B. Espinasse, R. Qi, R. Lubica, M. Poncz, D. B. Cines, M. R. Wiesner, and G. M. Arepally
Determinants of PF4/heparin immunogenicity
Blood, December 15, 2007; 110(13): 4253 - 4260.
[Abstract] [Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
A. Gray, D. E. Wallis, M. J. Hursting, E. Katz, and B. E. Lewis
Argatroban Therapy for Heparin-Induced Thrombocytopenia in Acutely Ill Patients
Clinical and Applied Thrombosis/Hemostasis, October 1, 2007; 13(4): 353 - 361.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
J. H. Levy, K. A. Tanaka, and M. J. Hursting
Reducing Thrombotic Complications in the Perioperative Setting: An Update on Heparin-Induced Thrombocytopenia
Anesth. Analg., September 1, 2007; 105(3): 570 - 582.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. C. Kress, S. Aronson, M. L. McDonald, M. I. Malik, A. B. Divgi, A. J. Tector, F. X. Downey III, A. J. Anderson, M. Stone, and C. Clancy
Positive Heparin-Platelet Factor 4 Antibody Complex and Cardiac Surgical Outcomes
Ann. Thorac. Surg., May 1, 2007; 83(5): 1737 - 1743.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. M. Everett, R. Yeh, S. Y. Foo, D. Criss, E. M. Van Cott, M. Laposata, E. G. Avery, W. D. Hoffman, J. Walker, D. Torchiana, et al.
Prevalence of Heparin/Platelet Factor 4 Antibodies Before and After Cardiac Surgery
Ann. Thorac. Surg., February 1, 2007; 83(2): 592 - 597.
[Abstract] [Full Text] [PDF]

Home page
 Crit Care NurseHome page
M. F. Cooney
Heparin-induced thrombocytopenia: advances in diagnosis and treatment.
Crit. Care Nurse, December 1, 2006; 26(6): 30 - 36.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
E. Bennett-Guerrero, T. F. Slaughter, W. D. White, I. J. Welsby, C. S. Greenberg, H. El-Moalem, and T. L. Ortel
Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1567 - 1572.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
I.-K. Jang and M. J. Hursting
When Heparins Promote Thrombosis: Review of Heparin-Induced Thrombocytopenia
Circulation, May 24, 2005; 111(20): 2671 - 2683.
[Full Text] [PDF]

Home page
 ChestHome page
R. L. Levine
Finding Haystacks Full of Needles: From Opus to Osler
Chest, May 1, 2005; 127(5): 1488 - 1490.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. T. Gurbuz, W. G. Elliott, and A. A. Zia
Heparin-induced thrombocytopenia in the cardiovascular patient: diagnostic and treatment guidelines
Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 138 - 149.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. E. Warkentin and A. Greinacher
Heparin-Induced Thrombocytopenia: Recognition, Treatment, and Prevention: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest, September 1, 2004; 126(3_suppl): 311S - 337S.
[Abstract] [Full Text] [PDF]

Home page
 ASH Education BookHome page
D. B. Cines, J. B. Bussel, R. B. McMillan, and J. L. Zehnder
Congenital and Acquired Thrombocytopenia
Hematology, January 1, 2004; 2004(1): 390 - 406.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. E. Warkentin and A. Greinacher
Heparin-induced thrombocytopenia and cardiac surgery
Ann. Thorac. Surg., December 1, 2003; 76(6): 2121 - 2131.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. E. Warkentin and A. Greinacher
Heparin-induced thrombocytopenia and cardiac surgery
Ann. Thorac. Surg., August 1, 2003; 76(2): 638 - 648.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The Society of Thoracic Surgeons.