Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study

TPE seems to be a treatment that may improve outcomes by effectively removing fibrin degradation products and restoring coagulation status: fact or fiction?

“…We would like to thank Honore et al for their considerable comments. Firstly, we should emphasize three important points about our study: (1) we investigated the effect of therapeutic plasma exchange (TPE) on overall mortality, not mortality predictors, (2) we emphasized that "major thromboembolic events" were not detected, not only thromboembolic events, and (3) we did not mention the cause of deaths because all of them were multi-organ failure (MOF) caused by COVID-19 [1]. Even if "major thromboembolic events" are not detected, patients will be under risk in terms of micro-embolisms as long as their Ddimer levels are high and this could be a reason for MOF.…”

“…In the study, 95% and 80% of deaths were in GII and GIIb respectively although all therapies except TPE were similar. Additionally, in propensity score matching (PSM), 14 covariates including "the usage of steroid, interleukin blocker and cytokine filter" were matched [1]. Therefore, we think that the result of PSM is acceptable evidence for the effect of TPE on mortality in patients with high D-dimer level although the number of patients are limited.…”

“…Patrick M. Honore * , Leonel Barreto Gutierrez, Luc Kugener, Sebastien Redant, Rachid Attou, Andrea Gallerani and David De Bels Gucyetmez et al, noting that elevated D-dimer levels have been found as a predictor for mortality in patients with COVID-19 pneumonia, concluded that therapeutic plasma exchange (TPE) seems to be a treatment that may improve outcomes by effectively removing fibrin degradation products (FDPs) and restoring coagulation status [1]. We are not sure that the authors have demonstrated the point that they intended to make.…”

“…They propose the use of TPE to remove FDPs, with the rationale that while unfractionated heparin (UFH) and low molecular weight heparin (LMWH) decrease production of FDPs, they cannot contribute to the metabolization of existing FDPs [1]. After propensity score matching, the mortality rate, in the patients with D-dimer level ≥ 2 mg/L, was 8.3% in patients who received TPE (TPE +) versus 58.3% in those who did not (TPE −), with no thromboembolic events detected in either sub-group [1]. While there was a reduction in the D-dimer levels in the TPE + group and not in the TPE − group, this cannot automatically be assumed to be the underlying cause of the decreased mortality rate.…”

The Artificial-Liver Blood-Purification System Can Effectively Improve Hypercytokinemia for COVID-19

“…Hence, the timely control of cytokine storms and reduction in inflammatory cell infiltration in the lungs are key to reducing COVID-19-related deaths (6). Multiple therapeutic strategies, such as antibody therapies with tocilizumab, sarilumab, and siltuximab and blood-purification techniques (BPT), including therapeutic plasma exchange (TPE), absorption, perfusion, and blood plasma filtration, among others, might potentially be effective for COVID-19 treatment (7)(8)(9)(10).…”