Platelet Factor 4-Heparin Antibody as a Predictor of Cardiovascular and Thrombotic Events in Hemodialysis

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in hemodialysis patients, with both traditional and nontraditional risk factors contributing to its high prevalence. Platelet factor 4-heparin antibody (PF4-H Ab) has been implicated in thrombotic complications, but their role in cardiovascular risk among hemodialysis patients remains unclear. Objective: This study aims to evaluate the association between PF4-H Ab and cardiovascular risk in end-stage renal disease (ESRD) patients on maintenance hemodialysis.
Patients and methods: This cross-sectional study included 80 hemodialysis patients recruited from Shebein El-Kom Fever Hospital, Menoufia, Egypt. Patients were classified based on cardiovascular risk and underwent enzyme-linked immunosorbent assay (ELISA) testing for PF4-H Ab.
Results: Of the 80 patients included, 36 (45%) tested positive for PF4-H Ab, while 44 (55%) were negative.  40 patients were classified as having cardiovascular risk, 22 of them (55%) tested positive for PF4-H Ab, while 18 (45%) were negative. The prevalence of congestive heart failure was significantly higher in PF4-H Ab-positive patients (36.4% vs. 0%, p = 0.005). Univariate analysis identified multiple factors associated with cardiovascular risk, but in multivariate analysis, only reduced ejection fraction (EF) remained a significant independent predictor (p = 0.024). ROC analysis demonstrated moderate discrimination for   PF4-H Ab in cardiovascular risk prediction (AUC = 0.635, p = 0.038), with sensitivity and specificity of 65%.
Conclusion: The moderate diagnostic performance of PF4-H Ab suggests that it may have some clinical relevance but lacks sufficient sensitivity and specificity to be used as a standalone biomarker for cardiovascular risk stratification in hemodialysis patients. Further research is needed to clarify its role in cardiovascular complications in ESRD populations.