Plasmapheresis May Be an Option in Urgent Management of Heparin-Induced Thrombocytopenia in the Setting of Acute Intracerebral Hemorrhage

Iluonakhamhe, Emitseilu K.; Ibekwe, Oluchukwu; Samuel, Sophie; Zakaria, Asma

doi:10.1007/s12028-014-0052-2

Cited by 12 publications

(15 citation statements)

References 15 publications

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“…Because this finding is consistent with reports in the literature, it is not surprising that for the CS indication, TPE treatment parameters such as plasma volume processed, number of procedures performed, and timing of the procedure prior to surgery were more clearly defined than for acute HIT with thrombosis. Nevertheless, there is still some variation in the number of TPE procedures needed for effective antibody reduction . Our survey findings appear to demonstrate equipoise between the number of CS patients that are treated with a set number of TPE procedures vs those treated to laboratory or clinical response.…”

Section: Discussionmentioning

confidence: 62%

“…However, once HIT is diagnosed, the primary course of action is to stop the offending anticoagulant and transition the patient to a parenteral DTI . As DTIs are primarily used in the management of HIT, TPE only becomes relevant in selected circumstances such as when continued anticoagulation is contraindicated; there is ongoing clinical deterioration despite DTI therapy; or there is need for heparin re‐exposure in the setting of CS …”

Section: Discussionmentioning

confidence: 99%

“…These large intravascular anti‐heparin/PF4 antibody complexes can be removed using therapeutic plasma exchange (TPE). In fact, TPE has been demonstrated, in case reports and case series, to be effective in decreasing anti‐heparin/PF4 antibodies, treating acute HIT complications, and facilitating heparin re‐exposure in patients with acute or subacute HIT …”

Section: Introductionmentioning

confidence: 99%

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

Onwuemene

Zantek

Rollins‐Raval

et al. 2019

J of Clinical Apheresis

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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%).

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Onwuemene

Zantek

Rollins‐Raval

et al. 2019

J of Clinical Apheresis

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“…In one case, HIT antibodies decreased and HIPA became negative. 56 In the second case, HIPA was negative. 57 Post treatment heparin re-exposure Post-treatment heparin re-exposure occurred in two IVIGtreated cases.…”

Section: Changes In Hit Lab Parametersmentioning

confidence: 87%

“…Fourteen studies detailed the use of IVIG or TPE as initial therapy (see Table 2). Twelve studies included 13 case reports 46,[48][49][50][51][52][53][54][55][56][57][58] and one case series included four patients. 14 One case-controlled study of 44 patients reported aggregate data on 26 TPE-treated patients and is summarized separately.…”

Section: Treatment Indication 2: Initial Therapymentioning

confidence: 99%

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

et al. 2020

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Background: Immunomodulatory strategies in heparin-induced thrombocytopenia (HIT) include the use of intravenous immune globulin (IVIG) and therapeutic plasma exchange (TPE). The optimal application of these therapies is unknown and outcomes data are limited. We investigated treatment categories and laboratory and clinical outcomes of IVIG and/or TPE in HIT with a systematic literature review. Study Design and Methods: We searched MEDLINE, Embase, and Web of Science through December 2019 for studies combining controlled vocabulary and keywords related to thrombocytopenia, heparin, TPE, and IVIG. The primary outcome was treatment indication. Secondary outcomes were platelet recovery, HIT laboratory parameters, heparin re-exposure, and post-treatment course. Case-level data were analyzed by qualitative synthesis. Results: After 4241 references were screened, we identified 60 studies with four main categories of IVIG and/or TPE use as follows: (a) treatment of refractory HIT (n = 35; 31%); (b) initial therapy (n = 45; 40%); (c) cardiopulmonary bypass surgery (CPB; n = 30; 27%); and (d) other (n = 2; 2%). IVIG was most commonly used for the treatment of refractory HIT while TPE was primarily used to facilitate heparin exposure during CPB. Both IVIG and TPE were

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Use of therapeutic plasma exchange in heparin‐induced thrombocytopenia: A population‐based study

Júnior¹,

Boyle

Kuchibhatla

et al. 2021

J of Clinical Apheresis

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Background Heparin‐induced thrombocytopenia (HIT) is characterized by anti‐heparin/platelet factor 4 immune complexes, which are removed by therapeutic plasma exchange (TPE). Our main objective was to study TPE outcomes in HIT using a large administrative claims database. Study design and methods We used the National Inpatient Sample (NIS) to identify hospital discharges of adult patients (≥18) with a primary or secondary diagnosis of HIT. Cases were classified into two groups based on TPE use. The primary outcome was in‐hospital mortality. Secondary outcomes were thrombotic events, major bleeding, hospital length of stay (LOS), and charges. Multivariable regression analysis, controlling for age and medical comorbidities, was used to examine the association of TPE with study outcomes. Results A HIT diagnosis was made in 22 165 discharges, of which 90 (0.4%) received TPE. Corresponding national estimates are 106 435 and 439, respectively. TPE was not associated with decreased in‐hospital mortality (OR = 1.72; 95%CI: 0.93‐3.17, P = .085). However, TPE was associated with a higher likelihood of major bleeding (OR = 2.35; 95%CI: 1.40‐3.68, P = .0009), primarily driven by gastrointestinal bleeding (OR = 2.21; 95%CI: 1.17‐4.17, P = .015). TPE was also associated with higher hospital LOS (20.5 vs 10 day, P < .0001) and charges (USD 211181 vs USD 81654, P < .0001). Conclusion TPE's association with increased bleeding and a prolonged hospital course indicates that it is being used in HIT cases with a severe clinical phenotype. Future studies are needed to better characterize the HIT phenotype that will most benefit from TPE.

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Plasmapheresis May Be an Option in Urgent Management of Heparin-Induced Thrombocytopenia in the Setting of Acute Intracerebral Hemorrhage

Abstract: This case helps illustrate the utility of plasmapheresis in management of HIT when anticoagulation is contraindicated.

Cited by 12 publications

References 15 publications

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

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

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

Use of therapeutic plasma exchange in heparin‐induced thrombocytopenia: A population‐based study

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