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Therapeutic plasma exchange for management of heparin-induced thrombocytopenia: Results of an international practice survey.
Onwuemene, Oluwatoyosi A; Zantek, Nicole D; Rollins-Raval, Marian A; Raval, Jay S; Kiss, Joseph E; Ipe, Tina S; Kuchibhatla, Maragatha; Pagano, Monica B; Wong, Edward C C.
Afiliación
  • Onwuemene OA; Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina.
  • Zantek ND; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
  • Rollins-Raval MA; Department of Pathology, University of New Mexico, Albuquerque, New Mexico.
  • Raval JS; Department of Pathology, University of New Mexico, Albuquerque, New Mexico.
  • Kiss JE; Vitalant Northeast Division Blood Services, and University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Ipe TS; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
  • Kuchibhatla M; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
  • Pagano MB; Department of Laboratory Medicine, University of Washington, Seattle, Washington.
  • Wong ECC; Department of Coagulation, Quest Diagnostics, Nichols Institute, Chantilly, Virginia.
J Clin Apher ; 34(5): 545-554, 2019 Oct.
Article en En | MEDLINE | ID: mdl-31116461
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intercambio Plasmático / Trombocitopenia / Guías de Práctica Clínica como Asunto Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Apher Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intercambio Plasmático / Trombocitopenia / Guías de Práctica Clínica como Asunto Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Apher Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos