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J Clin Apher. 2019 May 22. doi: 10.1002/jca.21709. [Epub ahead of print]

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

Author information

1
Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina.
2
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
3
Department of Pathology, University of New Mexico, Albuquerque, New Mexico.
4
Vitalant Northeast Division Blood Services, and University of Pittsburgh, Pittsburgh, Pennsylvania.
5
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
6
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
7
Department of Laboratory Medicine, University of Washington, Seattle, Washington.
8
Department of Coagulation, Quest Diagnostics, Nichols Institute, Chantilly, Virginia.
9
Department of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.

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%).

CONCLUSION:

In a minority of responding institutions, TPE is most commonly used in HIT to prophylactically treat patients who will undergo heparin re-exposure during CS. Prospective studies are needed to more clearly define the role of TPE in HIT.

KEYWORDS:

heparin-induced thrombocytopenia; practice survey; therapeutic plasma exchange

PMID:
31116461
DOI:
10.1002/jca.21709

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