Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin

Nicole D Zantek, Shanna M Morgan, Paul F. Zantek, David C. Mair, Robert J. Bowman, Agnes Aysola

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Therapeutic plasma exchange (TPE) without plasma replacement results in coagulation factor removal. Warfarin decreases the activity of vitamin K dependent coagulation factors. The combined effect of TPE and warfarin on the coagulation system has not been studied. A prospective, observational study was conducted in patients undergoing TPE while on warfarin. One plasma volume TPEs were performed on the COBE Spectra Apheresis System (Terumo BCT, Lakewood, CO) with 5% albumin. International normalized ratio (INR), fibrinogen, and factor II activity were obtained pre and post procedure. Eight patients underwent 121 TPEs that met study criteria with pre and post data. The average pre values were INR 2.09 ± 0.58, fibrinogen 263 ± 76 mg/dl, and factor II 29 ± 16% and the average post values were INR 4.12 ± 1.44, fibrinogen 105 ± 31 mg/dl, and factor II 13 ± 7%. The pre-INR was ≥2.00 for 55% of TPEs. The pre value (Y0) predicts the post value (Y) by the following equations Y = -0.54 + 2.21Y0, Y =12.10 + 0.35Y 0, and Y =1.83 + 0.39Y0 for INR, fibrinogen, and factor II respectively. In conclusion, pre procedure laboratory values can predict the post laboratory values for patients on warfarin receiving single plasma volume TPE with albumin replacement. The post-INR is approximately twice the pre-INR. At normal and mildly elevated pre-INR, the effect of TPE on the INR is less marked. A single plasma volume TPE decreases the plasma level by ∼65% for fibrinogen and 60% for factor II. J. Clin. Apheresis 29:75-82, 2014. © 2013 Wiley Periodicals, Inc.

Original languageEnglish (US)
Pages (from-to)75-82
Number of pages8
JournalJournal of Clinical Apheresis
Volume29
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

Plasma Exchange
International Normalized Ratio
Therapeutic Uses
Warfarin
Prothrombin
Fibrinogen
Plasma Volume
Blood Component Removal
Blood Coagulation Factors
Albumins
Vitamin K
Therapeutics
Carbon Monoxide
Observational Studies
Prospective Studies

Keywords

  • International Normalized Ratio
  • apheresis
  • coumadin
  • factor II
  • fibrinogen

Cite this

Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin. / Zantek, Nicole D; Morgan, Shanna M; Zantek, Paul F.; Mair, David C.; Bowman, Robert J.; Aysola, Agnes.

In: Journal of Clinical Apheresis, Vol. 29, No. 2, 01.01.2014, p. 75-82.

Research output: Contribution to journalArticle

Zantek, Nicole D ; Morgan, Shanna M ; Zantek, Paul F. ; Mair, David C. ; Bowman, Robert J. ; Aysola, Agnes. / Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin. In: Journal of Clinical Apheresis. 2014 ; Vol. 29, No. 2. pp. 75-82.
@article{91bff5eea3f54d2380da427ab1f8d805,
title = "Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin",
abstract = "Therapeutic plasma exchange (TPE) without plasma replacement results in coagulation factor removal. Warfarin decreases the activity of vitamin K dependent coagulation factors. The combined effect of TPE and warfarin on the coagulation system has not been studied. A prospective, observational study was conducted in patients undergoing TPE while on warfarin. One plasma volume TPEs were performed on the COBE Spectra Apheresis System (Terumo BCT, Lakewood, CO) with 5{\%} albumin. International normalized ratio (INR), fibrinogen, and factor II activity were obtained pre and post procedure. Eight patients underwent 121 TPEs that met study criteria with pre and post data. The average pre values were INR 2.09 ± 0.58, fibrinogen 263 ± 76 mg/dl, and factor II 29 ± 16{\%} and the average post values were INR 4.12 ± 1.44, fibrinogen 105 ± 31 mg/dl, and factor II 13 ± 7{\%}. The pre-INR was ≥2.00 for 55{\%} of TPEs. The pre value (Y0) predicts the post value (Y) by the following equations Y = -0.54 + 2.21Y0, Y =12.10 + 0.35Y 0, and Y =1.83 + 0.39Y0 for INR, fibrinogen, and factor II respectively. In conclusion, pre procedure laboratory values can predict the post laboratory values for patients on warfarin receiving single plasma volume TPE with albumin replacement. The post-INR is approximately twice the pre-INR. At normal and mildly elevated pre-INR, the effect of TPE on the INR is less marked. A single plasma volume TPE decreases the plasma level by ∼65{\%} for fibrinogen and 60{\%} for factor II. J. Clin. Apheresis 29:75-82, 2014. {\circledC} 2013 Wiley Periodicals, Inc.",
keywords = "International Normalized Ratio, apheresis, coumadin, factor II, fibrinogen",
author = "Zantek, {Nicole D} and Morgan, {Shanna M} and Zantek, {Paul F.} and Mair, {David C.} and Bowman, {Robert J.} and Agnes Aysola",
year = "2014",
month = "1",
day = "1",
doi = "10.1002/jca.21294",
language = "English (US)",
volume = "29",
pages = "75--82",
journal = "Journal of Clinical Apheresis",
issn = "0733-2459",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin

AU - Zantek, Nicole D

AU - Morgan, Shanna M

AU - Zantek, Paul F.

AU - Mair, David C.

AU - Bowman, Robert J.

AU - Aysola, Agnes

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Therapeutic plasma exchange (TPE) without plasma replacement results in coagulation factor removal. Warfarin decreases the activity of vitamin K dependent coagulation factors. The combined effect of TPE and warfarin on the coagulation system has not been studied. A prospective, observational study was conducted in patients undergoing TPE while on warfarin. One plasma volume TPEs were performed on the COBE Spectra Apheresis System (Terumo BCT, Lakewood, CO) with 5% albumin. International normalized ratio (INR), fibrinogen, and factor II activity were obtained pre and post procedure. Eight patients underwent 121 TPEs that met study criteria with pre and post data. The average pre values were INR 2.09 ± 0.58, fibrinogen 263 ± 76 mg/dl, and factor II 29 ± 16% and the average post values were INR 4.12 ± 1.44, fibrinogen 105 ± 31 mg/dl, and factor II 13 ± 7%. The pre-INR was ≥2.00 for 55% of TPEs. The pre value (Y0) predicts the post value (Y) by the following equations Y = -0.54 + 2.21Y0, Y =12.10 + 0.35Y 0, and Y =1.83 + 0.39Y0 for INR, fibrinogen, and factor II respectively. In conclusion, pre procedure laboratory values can predict the post laboratory values for patients on warfarin receiving single plasma volume TPE with albumin replacement. The post-INR is approximately twice the pre-INR. At normal and mildly elevated pre-INR, the effect of TPE on the INR is less marked. A single plasma volume TPE decreases the plasma level by ∼65% for fibrinogen and 60% for factor II. J. Clin. Apheresis 29:75-82, 2014. © 2013 Wiley Periodicals, Inc.

AB - Therapeutic plasma exchange (TPE) without plasma replacement results in coagulation factor removal. Warfarin decreases the activity of vitamin K dependent coagulation factors. The combined effect of TPE and warfarin on the coagulation system has not been studied. A prospective, observational study was conducted in patients undergoing TPE while on warfarin. One plasma volume TPEs were performed on the COBE Spectra Apheresis System (Terumo BCT, Lakewood, CO) with 5% albumin. International normalized ratio (INR), fibrinogen, and factor II activity were obtained pre and post procedure. Eight patients underwent 121 TPEs that met study criteria with pre and post data. The average pre values were INR 2.09 ± 0.58, fibrinogen 263 ± 76 mg/dl, and factor II 29 ± 16% and the average post values were INR 4.12 ± 1.44, fibrinogen 105 ± 31 mg/dl, and factor II 13 ± 7%. The pre-INR was ≥2.00 for 55% of TPEs. The pre value (Y0) predicts the post value (Y) by the following equations Y = -0.54 + 2.21Y0, Y =12.10 + 0.35Y 0, and Y =1.83 + 0.39Y0 for INR, fibrinogen, and factor II respectively. In conclusion, pre procedure laboratory values can predict the post laboratory values for patients on warfarin receiving single plasma volume TPE with albumin replacement. The post-INR is approximately twice the pre-INR. At normal and mildly elevated pre-INR, the effect of TPE on the INR is less marked. A single plasma volume TPE decreases the plasma level by ∼65% for fibrinogen and 60% for factor II. J. Clin. Apheresis 29:75-82, 2014. © 2013 Wiley Periodicals, Inc.

KW - International Normalized Ratio

KW - apheresis

KW - coumadin

KW - factor II

KW - fibrinogen

UR - http://www.scopus.com/inward/record.url?scp=84899096555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899096555&partnerID=8YFLogxK

U2 - 10.1002/jca.21294

DO - 10.1002/jca.21294

M3 - Article

VL - 29

SP - 75

EP - 82

JO - Journal of Clinical Apheresis

JF - Journal of Clinical Apheresis

SN - 0733-2459

IS - 2

ER -