Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;59(5):1870-1879.
doi: 10.1111/trf.15191. Epub 2019 Feb 14.

Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

Kimberly L Hodulik  1   2 , Adam G Root  2 , Leila S Ledbetter  3 , Oluwatoyosi A Onwuemene  1
Affiliations

Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review

Kimberly L Hodulik et al. Transfusion. 2019 May.

Abstract

Therapeutic plasma exchange (TPE) removes coagulation proteins, but its impact on therapeutic anticoagulation is unknown. We performed a systematic review of the literature to determine the coagulation effects of TPE in patients receiving systemic anticoagulation. We searched MEDLINE, CINAHL, EMBASE, and Web of Science until June 2018 for studies combining controlled vocabulary and keywords related to therapeutic plasma exchange, plasmapheresis, anticoagulants, and therapy. The primary outcome was the effect of TPE on anti-Xa activity, activated partial thromboplastin time (aPTT), or international normalized ratio (INR). The secondary outcome was reports of post-TPE bleeding or thrombosis. A total of 1830 references were screened and eight studies identified. Our selected studies (five case reports and three case series) involved 23 patients and evaluated the effects of seven anticoagulants. Six studies of unfractionated heparin, low-molecular-weight heparins, and direct oral anticoagulants demonstrated an anti-Xa level decline. Two studies of unfractionated heparin and low-molecular-weight heparins showed an aPTT increase. One study of warfarin showed a post-TPE INR increase. Reports of post-TPE bleeding occurred in two patients and thrombosis in one. In patients receiving therapeutic anticoagulation, TPE is associated with anti-Xa activity decline and aPTT and INR increase. These coagulation changes do not appear to significantly increase bleeding or thrombotic risk. Our data suggest the need for prospective studies to investigate the true clinical impact of TPE on therapeutic anticoagulation.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure.
Figure.
1830 references were identified through database searching and other sources. After duplicates were removed, 1522 studies were title and abstract screened and 1471 studies were excluded. Fifty-one studies were assessed for full-text eligibility with 43 studies excluded: 25 for therapeutic anticoagulation not given; 8 due to being review articles; 7 due to anticoagulation parameters not documented; one meeting abstract was excluded in favor of the published manuscript; and 1 was excluded for being an animal study. The final tally of studies included for extraction was 8.
See this image and copyright information in PMC

References

    1. Wood L, Jacobs P. The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels. Journal of clinical apheresis. 1986;3(2):124–128. - PubMed
    1. Cid J, Carbasse G, Andreu B, Baltanas A, Garcia-Carulla A, Lozano M. Efficacy and safety of plasma exchange: ann 11-year single-center experience of 2730 procedures in 317 patients. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2014;51(2):209–214. - PubMed
    1. Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. Journal of clinical apheresis. 2007;22(5):270–276. - PubMed
    1. Thölking G, Mesters R, Dittrich R, Pavenstädt H, Kümpers P, Reuter S. Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM). PloS one. 2015;10(6):e0130402. - PMC - PubMed
    1. Blasi A, Cid J, Beltran J, Taura P, Balust J, Lozano M. Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry. Vox sanguinis. 2016;110(2):159–165. - PubMed

Publication types