Key result
Anticoagulation during TPE requires individualized monitoring and adjustment as replacement fluids significantly alter hemostasis.
Why the study?
Management of anticoagulation during therapeutic plasma exchange is complex due to hemostatic changes and lacks standardized guidelines.
How should anticoagulation be managed in patients undergoing therapeutic plasma exchange?
How should anticoagulation be managed in patients undergoing therapeutic plasma exchange?
Anticoagulation management during therapeutic plasma exchange requires individualized monitoring and adjustment due to significant hemostatic changes.
May warrant individualized anticoagulation monitoring in therapeutic plasma exchange; leaves open need for prospective trials to standardize protocols.
We surveyed multiple apheresis centers represented by the authors for their clinical approach to the management of anticoagulation issues during therapeutic plasma exchange (TPE). We present the results of their practices and a review of the pertinent literature. As plasma is removed during TPE, replacement with all or partial non-plasma-containing fluids (eg, 5% albumin) may lead to significant changes in hemostasis. These changes are amplified in patients who are receiving anticoagulation. We discuss various anticoagulants as well as the monitoring and adjustment of anticoagulation before, during, and after TPE. No single guideline can be applied, but rather, patients must be monitored individually, taking into account their often complex clinical conditions and medication profiles.
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Shunkwiler et al. (2017) conducted a review in Patients undergoing therapeutic plasma exchange receiving anticoagulation. Management of anticoagulation during therapeutic plasma exchange was evaluated. Management of anticoagulation during therapeutic plasma exchange requires individualized monitoring and adjustment, as replacement fluids can significantly alter hemostasis.
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