Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review.

Date

2019-05

Journal Title

Journal ISSN

Volume Title

Repository Usage Stats

37
views
15
downloads

Citation Stats

Abstract

Therapeutic plasma exchange (TPE) removes coagulation proteins, but its impact on therapeutic anticoagulation is unknown. We performed a systematic review of the literature to determine the coagulation effects of TPE in patients receiving systemic anticoagulation. We searched MEDLINE, CINAHL, EMBASE, and Web of Science until June 2018 for studies combining controlled vocabulary and keywords related to therapeutic plasma exchange, plasmapheresis, anticoagulants, and therapy. The primary outcome was the effect of TPE on anti-Xa activity, activated partial thromboplastin time (aPTT), or international normalized ratio (INR). The secondary outcome was reports of post-TPE bleeding or thrombosis. A total of 1830 references were screened and eight studies identified. Our selected studies (five case reports and three case series) involved 23 patients and evaluated the effects of seven anticoagulants. Six studies of unfractionated heparin, low-molecular-weight heparins, and direct oral anticoagulants demonstrated an anti-Xa level decline. Two studies of unfractionated heparin and low-molecular-weight heparins showed an aPTT increase. One study of warfarin showed a post-TPE INR increase. Reports of post-TPE bleeding occurred in two patients and thrombosis in one. In patients receiving therapeutic anticoagulation, TPE is associated with anti-Xa activity decline and aPTT and INR increase. These coagulation changes do not appear to significantly increase bleeding or thrombotic risk. Our data suggest the need for prospective studies to investigate the true clinical impact of TPE on therapeutic anticoagulation.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1111/trf.15191

Publication Info

Hodulik, Kimberly L, Adam G Root, Leila S Ledbetter and Oluwatoyosi A Onwuemene (2019). Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review. Transfusion, 59(5). pp. 1870–1879. 10.1111/trf.15191 Retrieved from https://hdl.handle.net/10161/27017.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Ledbetter

Leila Ledbetter

Prof Library Staff

Leila is the library liaison to the School of Nursing.

As a research specialist, Leila works with faculty, staff and students to provide library services such as: systematic reviews of the literature; classes on evidence-based practice, resources and tools; research consultations; and office hours.

AHIP, Academy of Health Information Professionals Distinguished Member
MLIS, School of Information Studies, University of Wisconsin at Milwaukee
BS, Biology, Marietta College

Onwuemene

Oluwatoyosi Adefunke Onwuemene

Associate Professor of Medicine

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.