Treatment with or without plasma exchange for patients with acquired thrombotic microangiopathy not associated with severe ADAMTS13 deficiency: a propensity score–matched study

Li, Ang; Makar, Robert S.; Hurwitz, Shelley; Uhl, Lynne; Kaufman, Richard M.; Stowell, Christopher P.; Dzik, Walter; Bendapudi, Pavan K.

doi:10.1111/trf.13654

Cited by 29 publications

(37 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, recent evidence has shown that when TMA occurs as the result of a systemic illness, the ADAMTS13 activity is typically normal or mildly deficient, and patients do not respond to PEX. 2 In these cases, the treatment should be directed toward treating the underlying disease or stopping the offending drug. In the following review, we will discuss specific etiologies of TMA that should be considered after acquired TTP has been ruled out by nondeficient ADAMTS13 activity (.10%) and alternatives to a diagnosis of aHUS are being considered (Table 1).…”

Section: Introductionmentioning

confidence: 99%

None of the above: thrombotic microangiopathy beyond TTP and HUS

Masias

Vasu

Cataland

2017

Blood

View full text Add to dashboard Cite

Acquired thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are appropriately at the top of a clinician’s differential when a patient presents with a clinical picture consistent with an acute thrombotic microangiopathy (TMA). However, there are several additional diagnoses that should be considered in patients presenting with an acute TMA, especially in patients with nondeficient ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity (>10%). An increased awareness of drug-induced TMA is also essential because the key to their diagnosis more often is an appropriately detailed medical history to inquire about potential exposures. Widespread inflammation and endothelial damage are central in the pathogenesis of the TMA, with the treatment directed at the underlying disease if possible. TMA presentations in the critically ill, drug-induced TMA, cancer-associated TMA, and hematopoietic transplant–associated TMA (TA-TMA) and their specific treatment, where applicable, will be discussed in this manuscript. A complete assessment of all the potential etiologies for the TMA findings including acquired TTP will allow for a more accurate diagnosis and prevent prolonged or inappropriate treatment with plasma exchange therapy when it is less likely to be successful.

show abstract

Section: Introductionmentioning

confidence: 99%

None of the above: thrombotic microangiopathy beyond TTP and HUS

Masias

Vasu

Cataland

2017

Blood

View full text Add to dashboard Cite

show abstract

“…Based on the literature, the turnaround time for this test from a reference laboratory is approximately 3 days . After 3 days, using the result of the ADAMTS13 assay, the subsequent management for this scenario is assumed to be identical to the scenarios involving the in‐house ADAMTS13 testing (i.e., the only difference is the 3‐day TPE). An in‐hospital ADAMTS13 analysis with TPE initiated only if the ADAMTS13 is less than 10% (i.e., confirmed TTP): When positive (for both true‐ and false‐positive cases), the patient undergoes TPE for 3 days, resulting in the same pathways as Scenario 1 with appropriate mortality rate adjustment for true‐ and false‐positive cases (Table ) . In cases when the patient's test result is negative (i.e., ADAMTS13 is ≥ 10%), TPE is not performed as TTP has been excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, therapeutic plasma exchange (TPE) is indicated for acquired TTP, which reduces the mortality rate to 10% to 30% . However, TPE has little efficacy in treating other forms of TMAs . For example, eculizumab, an anticomplement therapy, is the treatment of choice for atypical hemolytic uremic syndrome .…”

mentioning

confidence: 99%

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

et al. 2017

View full text Add to dashboard Cite

Background ADAMTS13 test distinguishes thrombotic thrombocytopenic purpura (TTP) from other thrombotic microangiopathies (TMAs). PLASMIC score helps determine the pretest probability of ADAMTS13 deficiency. Due to inherent limitations of both tests, and potential adverse effects and cost of unnecessary treatments, we performed a cost-effectiveness analysis (CEA) investigating the benefits of incorporating an in-hospital ADAMTS13 test and/or PLASMIC score into our clinical practice. Methods A CEA model was created to compare 4 scenarios for a patient with TMAs, utilizing either an in-house vs. send-out ADAMTS13 assay with or without prior risk stratification using PLASMIC scoring. Model parameters, including probabilities and costs, were gathered from the medical literature, except for the ADAMTS13 send-out and in-house tests, which were obtained from our institutional data. Results If only the cost is considered, in-house ADAMTS13 test for patients with intermediate-high risk PLASMIC score is the least expensive option ($4,732/patient). If effectiveness is assessed as measured by the number of averted deaths, send-out ADAMTS13 test is the most effective. Considering the cost/effectiveness ratio, the in-house ADAMTS13 test in patients with intermediate-high risk PLASMIC score is the best option, followed by the in-house ADAMTS13 test without the PLASMIC score. Conclusions In patients with clinical presentations of TMAs, having an in-hospital ADAMTS13 test to promptly establish the diagnosis of TTP appears to be cost-effective. Utilizing the PLASMIC score increases the cost-effectiveness of the in-house ADAMTS13 test. Our findings indicate the benefit of having a rapid and reliable in-house ADAMTS13 test, especially in the tertiary medical center.

show abstract

“…The second test, which was based on an assumption of common support, required the p-score density function of the two groups to be proximate, indicating similar characteristics of X in both groups after matching. Simultaneous satisfaction of the balancing hypothesis and the common support assumption would demonstrate that the farm households did in fact behave similarly [21].…”

Section: The Propensity Score Matching Proceduresmentioning

confidence: 99%

Impact of Land Use Rights Transfer on Household Labor Productivity: A Study Applying Propensity Score Matching in Chongqing, China

Wang

Xin

et al. 2016

Sustainability

View full text Add to dashboard Cite

Abstract:In order to improve the rural labor productivity and farmers' income, land use transfer was launched and encouraged in recent years, especially the Thirteenth Five-Year Plan (2016-2020. This study aims to shed light on the impact of land use rights transfer on household labor productivity, based on a case study of Chongqing in China. Studies have revealed that land use transfer entails a process of self-selection and does not occur in a random manner. The study, therefore, addressed the issue of sample selection by applying propensity score matching. The study results suggested significant differences in the effects of land use transfer on household labor productivity. Specifically, renting land from other households had a positive effect on total labor productivity (TLP) and agricultural labor productivity (ALP). Moreover, TLP and ALP were found to be higher for households that rented more land or that were located in plain areas. Renting out land had a robust and positive effect on the TLP and non-agricultural labor productivity (NALP). TLP and NALP were also higher for households that rented out more land or that were located in plain areas. These findings suggest that land use transfer should be actively encouraged in plain areas. However, in mountainous areas, there is a need to pay more attention to expanding agriculture to benefit poor and marginalized populations in these areas.

show abstract

Treatment with or without plasma exchange for patients with acquired thrombotic microangiopathy not associated with severe ADAMTS13 deficiency: a propensity score–matched study

Abstract: Our data suggest that routine use of TPE in the diverse group of TMA patients without severe ADAMTS13 deficiency may not significantly improve outcomes.

Cited by 29 publications

References 33 publications

None of the above: thrombotic microangiopathy beyond TTP and HUS

None of the above: thrombotic microangiopathy beyond TTP and HUS

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

Impact of Land Use Rights Transfer on Household Labor Productivity: A Study Applying Propensity Score Matching in Chongqing, China

Contact Info

Product

Resources

About