Key result
Therapeutic plasma exchange is linked to reduced anti-Xa activity alongside increased aPTT and INR.
Why the study?
Therapeutic plasma exchange removes coagulation proteins, but its impact on therapeutic anticoagulation is unknown.
Does therapeutic plasma exchange alter coagulation parameters in patients receiving therapeutic anticoagulation?
Systematic Review (n=23)
Does therapeutic plasma exchange alter coagulation parameters in patients receiving therapeutic anticoagulation?
Therapeutic plasma exchange alters measurable coagulation parameters such as anti-Xa, aPTT, and INR, suggesting these assays may be unreliable indicators of anticoagulation status during TPE.
Clinicians should interpret anti-Xa, aPTT, and INR cautiously during TPE; confirms effects on coagulation assays in anticoagulated patients.
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.
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Hodulik et al. (2019) conducted a systematic review in Patients receiving systemic anticoagulation (n=23). Therapeutic plasma exchange was evaluated on Post-TPE change in anticoagulant-specific coagulation parameters, including anti-Xa activity, aPTT, and INR. In patients receiving therapeutic anticoagulation, therapeutic plasma exchange is associated with a decline in anti-Xa activity and an increase in aPTT and INR levels.
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