Protein Information

Name PF4
Synonyms CXCL 4; CXCL4; Iroplact; Oncostatin A; PF 4; PF4; Platelet factor 4; Platelet factor 4 precursor…

Compound Information

Name warfarin
CAS

Reference List

PubMed Abstract RScore(About this table)
19018128 Abdel-Wahab OI, Rosovsky RP, Warth JA: Warfarin-induced skin necrosis in a patient with heparin-induced thrombocytopenia: two diseases or one?. Acta Haematol. 2008;120(2):117-22. Epub 2008 Nov 19.

Heparin/platelet factor 4 antibody, sent on hospital day 9, returned positive and (14) C-serotonin release assay was also positive.
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18829068 Hassell K: Heparin-induced thrombocytopenia: diagnosis and management. Thromb Res. 2008;123 Suppl 1:S16-21. Epub 2008 Oct 1.

Heparin-induced thrombocytopenia (HIT) is an immune reaction in response to platelet factor 4-heparin complexes, which results in increased platelet activation and thrombocytopenia beginning on the 4th-5th day after heparin exposure induced by IgG antibody production.
Warfarin therapy, if indicated, should be avoided until platelet recovery.
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19788623 Ichinoe M, Mikami T, Ujiie S, Suzuki K, Okayasu I: Heparin-induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: autopsy case after long-term follow up. Pathol Int. 2009 Oct;59(10):757-61.

Because serum antibodies against heparin/PF4 complex were detected, he was diagnosed as having HIT, and warfarin and argatroban were administered instead of heparin.
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19452409 Kannan M, Saxena R, Adiguzel C, Fareed J: An update on the prevalence and characterization of H-PF4 antibodies in Asian-Indian patients. Semin Thromb Hemost. 2009 Apr;35(3):337-43. Epub 2009 May 18.

Heparin is the second most widely used anticoagulant/antithrombotic agent besides warfarin and is commonly used for various purposes such as treatment and surgical indications.
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18302088 Linkins LA, Warkentin TE: The approach to heparin-induced thrombocytopenia. . Masui. 2008 Apr;57(4):471-3.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic drug reaction caused by platelet-activating antibodies that recognize multimolecular complexes of platelet factor 4 (PF4) bound to heparin.
Coumarins (e.g., warfarin) are therefore contraindicated during the acute (thrombocytopenic) phase of HIT.
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20008202 Ortel TL: Heparin-induced thrombocytopenia: when a low platelet count is a mandate for anticoagulation. Semin Respir Crit Care Med. 2008 Feb;29(1):66-74.

Warfarin therapy should not be initiated until the platelet count has recovered and the patient is systemically anticoagulated, and vitamin K should be administered to patients receiving warfarin at the time of diagnosis of HIT.
Heparin-induced thrombocytopenia (HIT) is an immune-mediated disorder caused by the development of antibodies to platelet factor 4 (PF4) and heparin.
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18416208 Kumano N, Ikeda S, Arimori Y, Ono T, Saeki S: [Heparin resistance associated with elevated factor VIII] . Am J Health Syst Pharm. 2008 Jun 15;65(12):1144-7.

Other results were as follows: protein C antigen, 40%; protein S antigen, 65%; factor VII, 50%; platelet factor 4, 12%; heparin cofactor II, 104%; von Willebrand factor antigen, 181%; heparin-PF4-IgG antibody, negative; factor VIII inhibitor, negative.
Warfarin was administered preoperatively.
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18406993 Nutescu EA, Shapiro NL, Chevalier A: New anticoagulant agents: direct thrombin inhibitors. . Cardiol Clin. 2008 May;26(2):169-87


In recent years, much emphasis has been placed on the development of direct thrombin inhibitors (DTIs) that offer benefits over agents like heparin and warfarin including the inhibition of both circulating and clot-bound thrombin; a more predictable anticoagulant response, because they do not bind to plasma proteins and are not neutralized by platelet factor 4; lack of required cofactors, such as antithrombin or heparin cofactor II; inhibiting thrombin-induced platelet aggregation; and absence of induction of immune-mediated thrombocytopenia.
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18541684 Howard-Thompson A, Usery JB, Lobo BL, Finch CK: Heparin-induced thrombocytopenia complicated by warfarin-induced skin necrosis. v-vi.

Lepirudin was initiated and a heparin platelet factor 4 (PF4) antibody test was performed.
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20353743 Roncon-Albuquerque R Jr, Beco A, Ferreira AL, Gomes-Carvalho C, Costa A, Frazao J, Pestana M, von Hafe P: Therapeutic implications of heparin-induced thrombocytopenia complicating acute hemodialysis. Clin Nephrol. 2010 Apr;73(4):326-30.

Circulating anti-heparin-PF4 complex antibodies were detected.
All sources of heparin were discontinued and alternative anticoagulation was initiated with argatroban, a direct-thrombin inhibitor with hepatic clearance, followed by transition to warfarin.
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