Hemostatic effects of therapeutic plasma exchange: A concise review

Júnior, Alexandre Soares Ferreira; Hodulik, Kimberly L.; Barton, Karen D.; Onwuemene, Oluwatoyosi A.

doi:10.1002/jca.21973

Cited by 9 publications

(23 citation statements)

References 104 publications

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“…An area of potential concern for the apheresis practitioner is the type of replacement fluid to be used during TA, notably TPE. The reader should be cognizant of the risk of coagulation factor depletion (especially fibrinogen), particularly after daily TPE use in some clinical settings 12 . Coagulation factor replacement (e.g., plasma or cryoprecipitate supplementation) may be considered in these situations.…”

Section: Methodsmentioning

confidence: 99%

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

Self Cite

211

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. In the Ninth Edition, the JCA Special Issue Writing Committee has incorporated systematic review and evidence-based approaches in the grading of evidence and categorization of apheresis indications to make recommendations on the use of apheresis in a wide variety of diseases and conditions. This edition has largely maintained the general layout and concept of a fact sheet introduced in the Fourth Edition (2007). Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease or medical condition. The Ninth Edition of the JCA Special Issue comprises 91 fact sheets and

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Section: Methodsmentioning

confidence: 99%

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

Self Cite

211

View full text Add to dashboard Cite

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“…Dilutional coagulopathy occurs when the patients’ plasma is exchanged with albumin or saline [ 1 , 16 ]. However, TPE does not remove single factors but leads to a balanced reduction of pro- and anticoagulant proteins [ 17 ], which might explain the relatively low prevalence of bleeding [ 18 ]. Nevertheless, there is significant uncertainty with regards to both coagulation monitoring during exchange regimens and the cumulative effect of multiple exchange sessions [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

Research priorities for therapeutic plasma exchange in critically ill patients

David¹,

Russell²,

Castro³

et al. 2023

ICMx

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Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to “TPE in the critically ill patient”. These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk–benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.

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“…Outcome measures used to determine efficacy of fluid replacement were disease specific and none of the three studies showed any benefit of TPE over standard treatment. Randomised control trials are needed to compare the cost‐effectiveness of different TPE fluids, 29 and in particular NS.…”

Section: Discussionmentioning

confidence: 99%

Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study

Kohli

Allen

Platton

et al. 2022

J of Clinical Apheresis

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Introduction: Therapeutic plasma exchange (TPE) is used for several chronic conditions with little evidence on the efficacy and safety of different choice of replacement fluid. Measurement of haemostasis, particularly in vitro thrombin generation, could play a role in determining the immediate efficacy of different fluid replacement. Aim: To determine the impact of different TPE replacement fluid regimens on haemostatic assays. Methods: Prospective observational multi-centre cohort study in adult patients 18 years and older evaluating haemostatic changes between four different TPE regimens: (1) 5% human albumin solution (Alb) only, (2) 50:50 mix of 5% Alb + modified gelatin, (3) 70:30 mix of 5% Alb and normal saline (NS), and (4) solvent-detergent, virus-inactivated fresh frozen plasma (FFP) (either alone or combined with other fluids). Twenty-one haemostasis variables were analysed (procoagulant, anticoagulant and fibrinolytic factors) pre and post TPE sessions, including in vitro thrombin generation. Linear mixed modelling and canonical discriminant analyses were used to examine the effect of TPE fluid type on haemostatic variables.Results: A total of 31 patients with up to 5 TPE sessions each (131 sessions in total) were enrolled. Out of 21 markers analysed using linear mixed modelling, the main effects of fluid type were found to be significant for 19 markers (P < 0.05), excluding plasminogen activator inhibitor-1 antigen and thrombinanti-thrombin. Multivariate Analysis of Variance showed significant differences between the fluid types (Wilks' lambda = 0.07; F 63,245.61 = 5.50; P < 0.0001) and this was supported by a canonical discriminant analysis, which identified the 4 most discriminating markers for fluid types as thrombin generation (lag-time, time-to Peak), fibrinogen and Factor V. In our analyses, the effect of FFP on haemostasis was significantly greater compared with other

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Hemostatic effects of therapeutic plasma exchange: A concise review

Cited by 9 publications

References 104 publications

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Research priorities for therapeutic plasma exchange in critically ill patients

Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study

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