ArticleThe archives of bone and joint surgery2025
Anti-PF4/ Heparin Antibodies Early Seroconversion in Hip Fracture Patients Receiving Low Molecular Weight Heparin Prophylaxis: a Pilot Study of 100 Consecutive Patients.
Article in The archives of bone and joint surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Heparin-induced thrombocytopenia (HIT) represents a serious adverse reaction triggered by antibodies (anti-PF4/H) in heparin regimens. It is not clear if different low-molecular weight heparins (LMWHs) prompt distinct immunogenic responses in anti-PF4/H production and if these antibodies correlate with thrombocytopenia, thrombotic events, and early postoperative mortality. This pilot prospective study investigates the early output of anti-PF4/ H in elderly patients undergoing proximal femoral nailing for an intertrochanteric hip fracture surgery. Methods: A total of 100 consecutive patients (72 females) with surgically treated intertrochanteric hip fractures were prospectively included. Ninety-four patients were available for the final follow-up. Twenty-seven patients received bemiparin, 42 enoxaparin and 25 tinzaparin. The levels of anti-PF4/H using the semi-quantitative latex-enhanced immunoassay; HemosIL® HIT-Ab(PF4-H) and platelets (PLT) levels were measured on the admission day and on day 5 following LMWH administration. Patients were followed up for at least 3 months for major thrombotic events and all-cause mortality. Results: No patient developed clinically evident HIT, while 6 (6.4%) experienced thrombotic complications, and 22 (23.4%) passed away within 3 months after surgery. None of the patients with thrombotic complications tested positive for anti-PF4/H. Upon evaluating patients' seroconversion by day 5, six out of 94 (6.4%) patients tested positive for anti-PF4/H. Among them, three patients received bemiparin, two tinzaparin, and one enoxaparin. No statistically significant variance was observed in anti-PF4/H seroconversion between different types of LMWHs (p-value = 0.545) or in PLT count deviations (p-value = 0.990). Conclusion: This pilot prospective study investigated anti-PF4/H production in older patients with hip fractures receiving different LMWHs. Preliminary results suggest that all tested anticoagulants have similar immunogenicity profiles in terms of PF4/H sensitization. These findings highlight the overall safety of LMWHs in elderly hip fracture patients. Moreover, the presence of anti-PF4/H appears unrelated to PLT fluctuations, subsequent VTE events and early postoperative mortality.
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