Plasma exchange for heparin‐induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field

Cho, Joseph H; Parilla, Megan; Treml, Angela; Wool, Geoffrey D.

doi:10.1002/jca.21671

Cited by 11 publications

(12 citation statements)

References 49 publications

(97 reference statements)

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“…In this category, there are 14 studies with 30 cases. 5,[60][61][62][63][64][65][66][67][68] Case-level data are summarized in Table 3.…”

Section: Treatment Indication 3: Cardiopulmonary Bypass Surgerymentioning

confidence: 99%

“…In 29 cases, the average number of TPE was three (range 1-8). 5,31,[61][62][63][64][65][66][67][68][69][70][71] One patient reported as undergoing two TPEs underwent two CPB procedures and received one TPE prior to each CPB case. In 24 cases reporting the treatment schedule, cases were treated once (n = 14), daily (n = 5), every other day (n = 3), and daily/every other day (n = 2).…”

Section: Tpe Parametersmentioning

confidence: 99%

“…The outcomes reported were changes in HIT lab parameters in 28 cases (93%), heparin re-exposure without thrombosis in 29 cases (97%), 5,31,[61][62][63][64][65][66][67][68][69][70][71] and post-operative outcomes.…”

Section: Post-ivig And/or Tpe Outcomesmentioning

confidence: 99%

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Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

et al. 2020

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Background: Immunomodulatory strategies in heparin-induced thrombocytopenia (HIT) include the use of intravenous immune globulin (IVIG) and therapeutic plasma exchange (TPE). The optimal application of these therapies is unknown and outcomes data are limited. We investigated treatment categories and laboratory and clinical outcomes of IVIG and/or TPE in HIT with a systematic literature review. Study Design and Methods: We searched MEDLINE, Embase, and Web of Science through December 2019 for studies combining controlled vocabulary and keywords related to thrombocytopenia, heparin, TPE, and IVIG. The primary outcome was treatment indication. Secondary outcomes were platelet recovery, HIT laboratory parameters, heparin re-exposure, and post-treatment course. Case-level data were analyzed by qualitative synthesis. Results: After 4241 references were screened, we identified 60 studies with four main categories of IVIG and/or TPE use as follows: (a) treatment of refractory HIT (n = 35; 31%); (b) initial therapy (n = 45; 40%); (c) cardiopulmonary bypass surgery (CPB; n = 30; 27%); and (d) other (n = 2; 2%). IVIG was most commonly used for the treatment of refractory HIT while TPE was primarily used to facilitate heparin exposure during CPB. Both IVIG and TPE were

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“…In this category, there are 14 studies with 30 cases. 5,[60][61][62][63][64][65][66][67][68] Case-level data are summarized in Table 3.…”

Section: Treatment Indication 3: Cardiopulmonary Bypass Surgerymentioning

confidence: 99%

Section: Tpe Parametersmentioning

confidence: 99%

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Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

et al. 2020

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“…Plasma exchange may be performed in patients undergoing ECMO who have heparin-induced HIT or significant thrombosis and require the rapid elimination of excessive anti-PF4-heparin antibodies [187,188]. Several studies have shown that plasma exchange is effective for HIT [189].…”

Section: Plasma Exchange Recommendation 25: Plasma Exchange Eliminatementioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

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Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.

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“…These large intravascular anti‐heparin/PF4 antibody complexes can be removed using therapeutic plasma exchange (TPE). In fact, TPE has been demonstrated, in case reports and case series, to be effective in decreasing anti‐heparin/PF4 antibodies, treating acute HIT complications, and facilitating heparin re‐exposure in patients with acute or subacute HIT …”

Section: Introductionmentioning

confidence: 99%

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

Onwuemene

Zantek

Rollins‐Raval

et al. 2019

J of Clinical Apheresis

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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%).

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Plasma exchange for heparin‐induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field

Cited by 11 publications

References 49 publications

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

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

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