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.
Bibliographical noteFunding Information:
All authors contributed to survey development, data analysis, writing the manuscript, and/or critical review and editing of the manuscript. The authors acknowledge and thank Dr. Leonard Boral for his critical manuscript review. This project was supported by a grant to O.A.O from the Hemostasis and Thrombosis Research Society, supported by an unrestricted educational grant from Shire, PLC.
N.D.Z. received research funding from Octapharma and has financial interests in Endo International PLC and Boston Scientific. T.S.I. received research funding from Terumo BCT and Cerus Corporation. E.W. is an employee of Quest Diagnostics. The other authors have no relevant conflict of interest to disclose.
© 2019 Wiley Periodicals, Inc.
- heparin-induced thrombocytopenia
- practice survey
- therapeutic plasma exchange