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Communication Dans Un Congrès Année : 2023

PB0491 Patients from Different Settings Receiving Unfractionated Heparin (DEXHEP Study): Impact of PF4 on Anti-Xa Levels

Résumé

Background: In the DEXHEP study including 165 patients receiving unfractionated heparin (UFH), we reported that anti-Xa levels were higher when using a reagent containing dextran sulphate (DS) versus no DS. DS dissociates UFH/neutralizing protein (such as PF4) complexes. However, the impact of PF4 on the variability of anti-Xa levels measured with or without DS and using CTAD or citrate collection tubes is not known. Aims: To measure PF4 concentrations in citrate and CTAD samples from patients in different clinical settings receiving UFH and to assess the association between anti-Xa and PF4 levels. Methods: Blood was collected into citrated and CTAD tubes in four groups of patients. Anti-Xa assays were performed with seven assay/analyser combinations. PF4 levels were measured with ZymutestTM PF4 (Hyphen- Biomed) kit. Results: Citrated and CTAD samples from 144 patients were analysed. PF4 levels were higher in citrated samples (+351% [+301;+406], p < 0.0001) (Figure1), despite short preanalytical time-periods (88% of blood centrifuged within 2 h). Pneumatic transportation increased PF4 levels, with a greater effect in CTAD tubes (+87%, p < 0.0001) than in citrated tubes (+32%, p = 0.003). However, its effect on anti-Xa levels is less stringent and depends on the patients group. In CTAD samples, anti-Xa levels were higher (+15%, p = 0.005) than in citrated samples. The difference of anti-Xa levels between citrate and CTAD tended to be higher when the differences of PF4 concentrations increased (beyond around 200 ng/mL) (Figure2). The difference was observed with all commercially available reagents used regardless the presence or not of DS Conclusion(s): CTAD minimizes but might not be sufficient to fully prevent ex-vivo PF4 release. The PF4 release is increased by pneumatic transpor- tation. The presence of PF4 may affect anti-Xa levels but does not totally explain the differences of anti-Xa levels observed with or without DS. The reason for higher anti-Xa levels obtained with DS reagents still needs further explorations

Domaines

Hématologie
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Dates et versions

hal-04507728 , version 1 (17-03-2024)

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P. Savard, E. Curis, I. Gouin-Thibault, M. Toussaint-Hacquard, C. Delassasseigne, et al.. PB0491 Patients from Different Settings Receiving Unfractionated Heparin (DEXHEP Study): Impact of PF4 on Anti-Xa Levels. 2023 ISTH Congress, International Sociéty of Haematology, Jun 2023, Montreal (Canada), Canada. pp.101891, ⟨10.1016/j.rpth.2023.101891⟩. ⟨hal-04507728⟩
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