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

Abstract

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%).

Heparin‐induced thrombocytopenia associated with collection of hematopoietic progenitor cells by apheresis

“…The use of TPE for HIT‐associated thrombosis is an American Society for Apheresis (ASFA) category III indication with evidence grade 2C . Our performance of a series of 1.0 plasma volume TPE with 5% albumin as the exclusive replacement fluid to target a significant decrease in PF4 antibodies is consistent with how others have used TPE to treat HIT‐associated thrombosis . However, recent findings from in vitro studies suggest that IgG from donor plasma inhibits HIT antibody‐mediated platelet activation .…”

Clinical outcomes of cardiac surgery patients undergoing therapeutic plasma exchange for heparin‐induced thrombocytopenia

“…To date, TPE is scarcely used for HIT in most institutions, mostly because it is not recognized as an option. In a recent survey [26], only 37% of the surveyed institutions used TPE for HIT for indications such as cardiovascular surgery and HIT‐associated thrombosis. There were no major complications from TPE.…”

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

“…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].…”