Therapeutic plasma exchange for management of heparin-induced thrombocytopenia: Results of an international practice survey.

Published

Journal Article

INTRODUCTION: Anti-heparin/platelet factor 4 antibody immune complexes resulting from heparin-induced thrombocytopenia (HIT) are removed by therapeutic plasma exchange (TPE). We sought to define TPE in HIT practice patterns using an international survey. METHODS: A 31-item online survey was disseminated through the American Society for Apheresis. After institutional duplicate responses were eliminated, a descriptive analysis was performed. RESULTS: The survey was completed by 94 respondents from 78 institutions in 18 countries. Twenty-nine institutions (37%) used TPE for HIT (YES cohort) and 49 (63%) did not (NO cohort). Most NO respondents (65%) cited "no requests received" as the most common reason for not using TPE. Of the 29 YES respondents, 10 (34%) gave incomplete information and were excluded from the final analysis, leaving 19 responses. Of these, 18 (95%) treated ≤10 HIT patients over a 2-year period. The most common indications were cardiovascular surgery (CS; 63%) and HIT-associated thrombosis (HT; 26%). The typical plasma volume processed was 1.0 (63% CS and 58% HT). For CS, the typical replacement fluid was plasma (42%) and for HT, it was determined on an individual basis (32%). For CS, patients were treated with a set number of TPE procedures (37%) or laboratory/clinical response (37%). For HT, the number of TPE procedures typically depended on laboratory/clinical response (42%). CONCLUSION: In a minority of responding institutions, TPE is most commonly used in HIT to prophylactically treat patients who will undergo heparin re-exposure during CS. Prospective studies are needed to more clearly define the role of TPE in HIT.

Full Text

Duke Authors

Cited Authors

  • Onwuemene, OA; Zantek, ND; Rollins-Raval, MA; Raval, JS; Kiss, JE; Ipe, TS; Kuchibhatla, M; Pagano, MB; Wong, ECC

Published Date

  • October 2019

Published In

Volume / Issue

  • 34 / 5

Start / End Page

  • 545 - 554

PubMed ID

  • 31116461

Pubmed Central ID

  • 31116461

Electronic International Standard Serial Number (EISSN)

  • 1098-1101

Digital Object Identifier (DOI)

  • 10.1002/jca.21709

Language

  • eng

Conference Location

  • United States