Detection of Anti-Platelet Factor 4 Antibodies in Acute and Chronic Thromboembolic Disease—A Pilot Study
5 affiliations
- 1Coagulation Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany
- 2Coagulation Research Centre Bethanien Hospital, 60389 Frankfurt, Germany
- 3Institute for Transfusion Medicine, University Hospital Greifswald, 17475 Greifswald, Germany
- 4Werfen, 08186 Lliçà d’Amunt, Barcelona, Spain
- 5Goethe University Frankfurt, Institute of Biostatistics and Mathemical Modelling, 60590 Frankfurt, Germany
Abstract
Heterogeneous antibodies directed against platelet factor 4 (PF4-Abs) are associated with heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT). Emerging evidence suggests that these antibodies may also occur in other thromboembolic diseases. In this pilot study, we assessed the prevalence of PF4-Abs in patients with acute thromboembolism and in patients with thromboembolic antiphospholipid syndrome (APS), a chronic autoimmune thrombophilia. Forty patients with acute thromboembolism and 43 patients with APS were included. Both heparin-dependent and heparin-independent PF4-Abs were evaluated using multiple assay platforms, including a prototype chemiluminescence assay for heparin-independent PF4-Abs, an anti-PF4/polyanion IgG chemiluminescence assay, a latex agglutination assay detecting anti-PF4/polyanion IgG/IgM/IgA antibodies, an anti-PF4/heparin IgG ELISA, and functional platelet activation tests. Across the different assays, positivity in at least one assay was observed in 27.5% (11/40) of patients with acute thromboembolism and 27.9% (12/43) of patients with APS. In most antibody-positive patients, no recent heparin exposure was documented. Functional platelet activation was predominantly absent, arguing against a classical HIT- or VITT-like mechanism. Overall, these results demonstrate assay-dependent PF4-Ab positivity in a substantial proportion of patients with acute and chronic thromboembolic conditions. Their clinical and pathogenic relevance remains unclear and warrants further investigation.
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BibTeX
@article{trunk2026detection,
title = {{Detection of Anti-Platelet Factor 4 Antibodies in Acute and Chronic Thromboembolic Disease—A Pilot Study}},
author = {Annabell Trunk and Jan Wesche and Stella Jacobi and Marina Bruch-Oms and Donata Metzler and Eva Herrmann and Thomas Thiele and Edelgard Lindhoff-Last},
journal = {International Journal of Molecular Sciences},
year = {2026},
month = nov,
doi = {10.3390/ijms27219899},
url = {https://www.mdpi.com/1422-0067/27/21/9899},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Detection of Anti-Platelet Factor 4 Antibodies in Acute and Chronic Thromboembolic Disease—A Pilot Study
AU - Annabell Trunk
AU - Jan Wesche
AU - Stella Jacobi
AU - Marina Bruch-Oms
AU - Donata Metzler
AU - Eva Herrmann
AU - Thomas Thiele
AU - Edelgard Lindhoff-Last
PY - 2026
DA - 2026/11/05
JO - International Journal of Molecular Sciences
DO - 10.3390/ijms27219899
UR - https://www.mdpi.com/1422-0067/27/21/9899
AB - Heterogeneous antibodies directed against platelet factor 4 (PF4-Abs) are associated with heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT). Emerging evidence suggests that these antibodies may also occur in other thromboembolic diseases. In this pilot study, we assessed the prevalence of PF4-Abs in patients with acute thromboembolism and in patients with thromboembolic antiphospholipid syndrome (APS), a chronic autoimmune thrombophilia. Forty patients with acute thromboembolism and 43 patients with APS were included. Both heparin-dependent and heparin-independent PF4-Abs were evaluated using multiple assay platforms, including a prototype chemiluminescence assay for heparin-independent PF4-Abs, an anti-PF4/polyanion IgG chemiluminescence assay, a latex agglutination assay detecting anti-PF4/polyanion IgG/IgM/IgA antibodies, an anti-PF4/heparin IgG ELISA, and functional platelet activation tests. Across the different assays, positivity in at least one assay was observed in 27.5% (11/40) of patients with acute thromboembolism and 27.9% (12/43) of patients with APS. In most antibody-positive patients, no recent heparin exposure was documented. Functional platelet activation was predominantly absent, arguing against a classical HIT- or VITT-like mechanism. Overall, these results demonstrate assay-dependent PF4-Ab positivity in a substantial proportion of patients with acute and chronic thromboembolic conditions. Their clinical and pathogenic relevance remains unclear and warrants further investigation.
SN - 1422-0067
ER -