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

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.

Figure 1.

The total number of survey respondents was 94. Based on pre-determined criteria (outlined in the methods), 16 duplicate responses from the same institution were removed. The resulting number of unique institutional responses was 78. Twenty-nine institutions indicated that TPE was used for the management of HIT, and 49 indicated that TPE was not used for HIT. Of the 29 that indicated TPE use for HIT, 10 provided incomplete responses, leaving a total number of 19 respondents’ data for analysis.