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

J Clin Apher. 2019 Oct;34(5):545-554. doi: 10.1002/jca.21709. Epub 2019 May 22.

Abstract

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%).

Conclusion: In a minority of responding institutions, TPE is most commonly used in HIT to prophylactically treat patients who will undergo heparin re-exposure during CS. Prospective studies are needed to more clearly define the role of TPE in HIT.

Keywords: heparin-induced thrombocytopenia; practice survey; therapeutic plasma exchange.

Publication types

  • Multicenter Study

MeSH terms

  • Cardiovascular Surgical Procedures / methods
  • Disease Management
  • Heparin / therapeutic use
  • Humans
  • Plasma Exchange / methods*
  • Practice Guidelines as Topic*
  • Premedication
  • Surveys and Questionnaires
  • Thrombocytopenia / chemically induced
  • Thrombocytopenia / therapy*

Substances

  • Heparin