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

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

Fingerprint

Plasma Exchange
Thrombocytopenia
Heparin
Therapeutics
Platelet Factor 4
Surveys and Questionnaires
Plasma Volume
Antigen-Antibody Complex
Thrombosis
Prospective Studies
Antibodies

Keywords

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

Cite this

Onwuemene, O. A., Zantek, N. D., Rollins-Raval, M. A., Raval, J. S., Kiss, J. E., Ipe, T. S., ... Wong, E. C. C. (2019). Therapeutic plasma exchange for management of heparin-induced thrombocytopenia: Results of an international practice survey. Journal of clinical apheresis, 34(5), 545-554. https://doi.org/10.1002/jca.21709

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.

In: Journal of clinical apheresis, Vol. 34, No. 5, 01.10.2019, p. 545-554.

Research output: Contribution to journalArticle

Onwuemene, OA, Zantek, ND, Rollins-Raval, MA, Raval, JS, Kiss, JE, Ipe, TS, Kuchibhatla, M, Pagano, MB & Wong, ECC 2019, 'Therapeutic plasma exchange for management of heparin-induced thrombocytopenia: Results of an international practice survey', Journal of clinical apheresis, vol. 34, no. 5, pp. 545-554. https://doi.org/10.1002/jca.21709
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. / Therapeutic plasma exchange for management of heparin-induced thrombocytopenia : Results of an international practice survey. In: Journal of clinical apheresis. 2019 ; Vol. 34, No. 5. pp. 545-554.
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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.",
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AU - Rollins-Raval, Marian A.

AU - Raval, Jay S.

AU - Kiss, Joseph E.

AU - Ipe, Tina S.

AU - Kuchibhatla, Maragatha

AU - Pagano, Monica B.

AU - Wong, Edward C.C.

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