Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry

Blasi, Annabel; Cid, Joan; Beltrán, Joan; Taurà, Pilar; Balust, Jaume; Lozano, Miguel

doi:10.1111/vox.12347

Cited by 17 publications

(34 citation statements)

References 56 publications

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“…A more appropriate assessment of the post‐TPE coagulation profile may be whole blood clotting assays. In fact, prospective whole blood clotting assay studies suggest that albumin‐only TPE alters fibrin clot formation . As measured by thromboelastography, TPE with albumin fluid replacement both alters clot structure and decreases clot formation and firmness.…”

Section: Discussionmentioning

confidence: 99%

“…In therapeutic plasma exchange (TPE), the process of plasma removal and replacement affects blood coagulation proteins . TPE‐mediated coagulation protein removal and its effects on fibrin clot formation alter the hemostatic profile . The coagulation profile is further modified by TPE‐related factors such as procedure frequency and duration, procedural plasma volume, and replacement fluid .…”

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confidence: 99%

“…1 TPE-mediated coagulation protein removal and its effects on fibrin clot formation alter the hemostatic profile. [2][3][4][5] The coagulation profile is further modified by TPE-related factors such as procedure frequency and duration, procedural plasma volume, and replacement fluid. 6 Despite TPE's effects on coagulation, studies have consistently demonstrated that TPE-associated bleeding risk is low.…”

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confidence: 99%

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Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

et al. 2019

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Therapeutic plasma exchange (TPE) removes coagulation proteins, but its impact on therapeutic anticoagulation is unknown. We performed a systematic review of the literature to determine the coagulation effects of TPE in patients receiving systemic anticoagulation. We searched MEDLINE, CINAHL, EMBASE, and Web of Science until June 2018 for studies combining controlled vocabulary and keywords related to therapeutic plasma exchange, plasmapheresis, anticoagulants, and therapy. The primary outcome was the effect of TPE on anti‐Xa activity, activated partial thromboplastin time (aPTT), or international normalized ratio (INR). The secondary outcome was reports of post‐TPE bleeding or thrombosis. A total of 1830 references were screened and eight studies identified. Our selected studies (five case reports and three case series) involved 23 patients and evaluated the effects of seven anticoagulants. Six studies of unfractionated heparin, low‐molecular‐weight heparins, and direct oral anticoagulants demonstrated an anti‐Xa level decline. Two studies of unfractionated heparin and low‐molecular‐weight heparins showed an aPTT increase. One study of warfarin showed a post‐TPE INR increase. Reports of post‐TPE bleeding occurred in two patients and thrombosis in one. In patients receiving therapeutic anticoagulation, TPE is associated with anti‐Xa activity decline and aPTT and INR increase. These coagulation changes do not appear to significantly increase bleeding or thrombotic risk. Our data suggest the need for prospective studies to investigate the true clinical impact of TPE on therapeutic anticoagulation.

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Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

et al. 2019

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“…In addition, five centers reported using membrane filtration and were excluded from analysis and 15 respondents dropped out of the survey prior to this question so their method of plasma separation is unknown. Furthermore, we did not inquire about other tests of hemostasis such as thromboelastography (TEG) and rotational elastometry (ROTEM) . However, based on the authors' experiences, the use of TEG and ROTEM was considered not to be a test routinely utilized during TPE treatment and therefore was not queried.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we did not inquire about other tests of hemostasis such as thromboelastography (TEG) and rotational elastometry (ROTEM). 17,35 However, based on the authors' experiences, the use of TEG and ROTEM was considered not to be a test routinely utilized during TPE treatment and therefore was not queried.…”

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Hemostasis testing and therapeutic plasma exchange: Results of a practice survey

Zantek

Pagano

Rollins‐Raval

et al. 2018

J of Clinical Apheresis

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Introduction Performing therapeutic plasma exchange (TPE) with albumin replacement decreases coagulation factor and platelet levels. No defined guidelines exist regarding laboratory testing to assess hemostasis in patients undergoing TPE. Materials and methods A survey to evaluate hemostasis testing with TPE was distributed using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 120 respondents per question. Descriptive analysis was performed with results reported as the number and/or frequency (%) of respondents to each question. Results The practices represented vary by institution type, number of apheresis procedures per year, and performance of TPE on children. Prior to TPE planned with albumin replacement, many respondents obtain laboratory studies for almost all patients (54.9% outpatients and 68.7% inpatients); however, some do not routinely obtain laboratory studies (9.7% outpatients and 4.4% inpatients). Hemoglobin/hematocrit, platelet count, fibrinogen, partial thromboplastin time (aPTT), and international normalized ratio (INR) are obtained prior to all TPE by 62.5%, 53.4%, 31.0%, 18.1%, and 17.7% of respondents, respectively; however, 1.0%, 8.7%, 29.0%, 38.3%, and 35.4%, respectively, do not routinely obtain these studies. Variation was observed in laboratory threshold values for action; the most common reported were hemoglobin/hematocrit <7 g/dL or 21% (31.0%), platelet count <50 × 109/L (24.1%), fibrinogen <100 mg/dL (65.3%), aPTT >reference range and >1.5 times reference range (tied, 28.1%), and INR >1.5 (20.7%). Conclusions Practice variation exists in hemostasis laboratory testing and threshold values for action with TPE. Further studies are needed to determine optimal hemostasis testing strategies with TPE.

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The Barcelona Hospital Clínic therapeutic apheresis database

Cid

Carbassé

Cid-Caballero

et al. 2017

J of Clinical Apheresis

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Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry

Abstract: A profound derangement of TEM parameters was observed after PE, evidenced by delay in the clot formation and reduction in the clot firmness. More studies are warranted to elucidate the clinical implications of derangement in TEM parameters in patients without concomitant coagulopathy.

Cited by 17 publications

References 56 publications

Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

Hemostasis testing and therapeutic plasma exchange: Results of a practice survey

The Barcelona Hospital Clínic therapeutic apheresis database

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