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

Oluwatoyosi A. Onwuemene, Nicole D. Zantek, Marian A. Rollins-Raval, Jay S. Raval, Joseph E. Kiss, Tina S. Ipe, Maragatha Kuchibhatla, Monica B. Pagano, Edward C.C. Wong

Research output: Contribution to journalArticle

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)545-554
Number of pages10
JournalJournal of Clinical Apheresis
Volume34
Issue number5
DOIs
StatePublished - Oct 1 2019

Keywords

  • heparin-induced thrombocytopenia
  • practice survey
  • therapeutic plasma exchange

ASJC Scopus subject areas

  • Hematology

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