The use of therapeutic apheresis in cardiovascular disease

Abstract

In the last few years, therapeutic apheresis (TA) has emerged as a valuable treatment option for certain life-threatening cardiovascular diseases (CVDs) and for all the cardiac dysfunctions caused by autoimmune or metabolic disorders. Besides the well-established indications for apheresis treatment, such as familial hypercholesterolaemia, hyperviscosity syndrome and thrombotic thrombocytopenic purpura (TTP), we discuss the novel approaches in the therapy of dilated cardiomyopathy, cardiac failure and some specific syndromes of severe dysfunction occurring after heart transplantation. The rationale for using apheresis in such patients is the contribution in immune modulation that this procedure can undoubtedly provide. The clinical course of TTP has dramatically changed, thanks to the introduction of therapeutic plasma exchange. Low-density lipoprotein apheresis has been extremely efficacious, safe and suitable for lowering cholesterol levels and can be used even for long-term treatment. In Waldenström macroglobulinaemia and other hyperviscosity syndromes, plasma exchange has demonstrated to be an efficient tool for reducing blood viscosity and the risk of a consequent cardiac dysfunction. However, TA may induce oxidative injury to erythrocytes, making these cells more prone to haemolysis and causing a significant reduction in their half-life. Ascorbate administration can be useful to lower the levels of hydrogen peroxide and proinflammatory mediators in patients undergoing apheresis. Further data are needed to support this benefit and to test other potential antioxidant therapies. Many of these therapeutic indications need further studies to be definitively approved, but preliminary data are encouraging.

The Effect of LDL-Apheresis and Rheohaemapheresis Treatment on Vitamin E

“…Ascorbate administration can be useful to lower the levels of hydrogen peroxide and proinflammatory mediators in patients undergoing apheresis (45). It was also initially hypothesized that ascorbic acid may decrease lipoprotein(a) concentrations; however, a study in 100 healthy people did not confirm this hypothesis (46).…”

Lateral ST-elevation myocardial infarction after donation of COVID-19 convalescent plasma in a naïve donor

“…7 8 It is also being studied as a novel therapy in patients with dilated cardiomyopathy. 9 There is controversial evidence about the effect of plasmapheresis on donor's hypercoagulability. This procoagulant effect was studied in 54 donors and it was found that in comparison to pre-plasmapheresis sample, post-plasmapheresis sample showed significant reduction of PT, increased clot growth velocity and increased endogenous thrombin generation turning normocoagulant plasma into a hypercoagulant one.…”

Spring at last …

“…In this issue we have two interesting reviews. One is from Professor Claudio Napoli and colleagues explaining how therapeutic apheresis, widely provided by transfusion medicine services, is an important tool in the management of patients with cardiac disease, not only for thrombotic thrombocytopenic purpura, but also for immune disorders affecting the heart and hyperlipidaemias (Pignalosa et al , ). Further expansion of these therapeutic services seems likely as technical improvements and additional tools and expertise enhance its application and reach.…”