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


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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Publication Info

Onwuemene, Oluwatoyosi A, Nicole D Zantek, Marian A Rollins-Raval, Jay S Raval, Joseph E Kiss, Tina S Ipe, Maragatha Kuchibhatla, Monica B Pagano, et al. (2019). Therapeutic plasma exchange for management of heparin-induced thrombocytopenia: Results of an international practice survey. Journal of clinical apheresis, 34(5). pp. 545–554. 10.1002/jca.21709 Retrieved from

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Oluwatoyosi Adefunke Onwuemene

Associate Professor of Medicine

Maragatha Kuchibhatla

Professor of Biostatistics & Bioinformatics

Statistical research methodology, analysis of repeated measurements, latent growth curve models, latent class growth models, classification and regression trees,
designing clinical trials, designing clinical trials in psychiatry -- both treatment and non-treatment
trials in various comorbid populations.

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