Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Abstract

Therapeutic plasma exchange (TPE) is a technique used to separate blood components into layers based on their density difference, thus removing plasma and exchanging it with replacement fluids. A variety of adverse reactions has been described during TPE. Thrombotic events, especially strokes, are extremely rare complications of TPE. Our patient was a 55-year-old female with history of decompensated nonalcoholic steatohepatitis (NASH) liver cirrhosis. She underwent an orthotopic liver transplant (OLT) that was complicated with asystole during reperfusion. Cardiac workup revealed a new atrial septal defect (ASD) with left to right flow. Within the first 5 days after surgery, she developed refractory and persistent hyperbilirubinemia, with total bilirubin levels as high as 42 mg/dL. Our plasmapheresis service was consulted to initiate TPE. Towards

Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange

“…Minor bleeding and thrombosis events associated with CVCs may be exacerbated by TPE‐associated removal of coagulation proteins and platelets 21‐23 . However, how CVCs interact with TPE to impact thrombosis or bleeding risk remains unknown 19,24‐28 …”

“…[21][22][23] However, how CVCs interact with TPE to impact thrombosis or bleeding risk remains unknown. 19,[24][25][26][27][28] To investigate thrombosis and bleeding outcomes of CVCs, we undertook an analysis of discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. 29…”