Selective Fibrinogen Apheresis for Improvement in Microvascular Hemodynamics

Kaplan, André A.

doi:10.1159/000109100

Cited by 2 publications

(2 citation statements)

References 8 publications

(11 reference statements)

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“…We successfully tested this novel concept and identified elevated fibrinogen as one possible marker for an acquired procoagulant state. Selective fibrinogen removal systems may offer an additional option in the future [8, 9]. Major limitations of this case are that we have not assessed plasma viscosity, von Willebrand factor activity, or markers of systemic inflammation (plasminogen activator inhibitor type‐1, procalcitonine).…”

Section: Discussionmentioning

confidence: 99%

Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single‐session therapeutic plasma exchange

Fülöp¹,

Cosmin²,

Juncos³

2011

J of Clinical Apheresis

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We report a case of a 17 year old white male with multiple fractures and multi-organ failure who developed oliguric acute renal failure requiring continuous renal replacement therapy. Repeated clotting of the extracorporeal circuit (ECC) prevented delivery of a minimally acceptable dose of renal replacement therapy despite adequate anticoagulation and dialysis catheter exchanges. Evaluation for a primary hypercoagulable state was negative, but his fibrinogen was elevated (1,320 mg/dL, normal range: 150–400 mg/dL), likely induced by his severe inflammatory state. A single session of therapeutic plasma exchange (TPE) with albumin and normal saline replacement was performed with subsequent drop in fibrinogen to 615 mg/dL. No further episodes of premature ECC clotting occurred, suggesting plasma factor(s) removed may have contributed to the clinical hypercoagulable state. TPE may play an adjunctive role in select cases of recurrent ECC clotting refractory to current anticoagulation techniques.

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Section: Discussionmentioning

confidence: 99%

Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single‐session therapeutic plasma exchange

Fülöp¹,

Cosmin²,

Juncos³

2011

J of Clinical Apheresis

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“…Apheresis is used for various diseases that involve circulating factors. Pretransplant desensitization, 1,2 autoimmune diseases, for example, myasthenia gravis and peripheral artery disease (PAD) 3‐7 are examples of situations where apheresis can be successfully used.…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen reconstitution after therapeutic apheresis: Comparison of double‐filtration plasmapheresis, plasma exchange, and immunoadsorption

Jouve

Marlu

Bennani

et al. 2021

J of Clinical Apheresis

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Background Fibrinogen reconstitution after therapeutic apheresis has been poorly studied. Apheresis modalities, for example, plasma exchange (PE), double‐filtration plasmapheresis (DFPP), or selective immunoadsorption (IA), may have different impacts. Methods We retrospectively investigated therapeutic apheresis sessions performed at our center across four modalities (PE, DFPP, and IA with or without plasma filtration). Fibrinogen levels were assessed at the beginning and end of each apheresis session, and immediately before the subsequent session. We adjusted measurements on hematocrit values to account for hemoconcentration. Results Between January 10, 2016 and March 2, 2020, we included 90 patients for a total of 754 apheresis sessions (PE: 35; DFPP: 351; IA only: 109; IA + plasma filtration: 259). Each patient received a median of five sessions (1Q 3; 3Q 9); median plasma volume treated was 5.5 L (1Q 4.3 L; 3Q 7.0 L). Within a session, DFPP and PE induced a significantly greater depletion of fibrinogen than both IA modalities, even after adjustment for the treated plasma volume. Median fibrinogen reconstitution was 0.8 (0.4‐1.2) g/L (median time between sessions: 38 hours). In multivariate analysis, fibrinogen reconstitution was significantly associated with intersession time (+0.66 g/L/log‐hour P < .001), apheresis modality (ANOVA; P < .001), initial fibrinogen concentration (+0.15 g/L per gram of fibrinogen; P < .001), and the last fibrinogen concentration from the previous apheresis session (−0.14 g/L per gram of fibrinogen; P < .001). In a model that considered hemoconcentration, the results were unchanged. Conclusions We demonstrate that fibrinogen reconstitution was highly variable between patients and apheresis sessions. Apheresis modalities had a significant impact on fibrinogen reconstitution, regardless of hemoconcentration.

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Selective Fibrinogen Apheresis for Improvement in Microvascular Hemodynamics

Cited by 2 publications

References 8 publications

Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single‐session therapeutic plasma exchange

Recurring extracorporeal circuit clotting during continuous renal replacement therapy resolved after single‐session therapeutic plasma exchange

Fibrinogen reconstitution after therapeutic apheresis: Comparison of double‐filtration plasmapheresis, plasma exchange, and immunoadsorption

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