Studies reporting TPE prior to cardiac surgery in HIT
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | TPE prescription . | Outcomes . |
|---|---|---|---|---|
| Welsby 201012 (11) Retrospective CS | HIT + within 2 wk of surgery (9) HIT + within 2 mo of surgery (2) HIPA − (11) Median preop OD 0.8e (0.7–2.2) | AVR (1) CABG (1) OHT (6) VAD (3) | 1 TPE in ORbc 1.3 PV Plasma | OD ↓50% → 84% 1 patient with left foot loss due to IABP. 3 deaths (3 mos, 6 mos, and 1 year post op) |
| Ramu 201847 (4) Retrospective CS | HIT and SRA + (2); HIT + SRA NR (2) | OHT (1) VAD (2) AVR, MVR (1) | 1 intraop TPE, 4-7 preop TPE | No perioperative thrombosis |
| Moreno Duarte13 (24) Retrospective CS | HIT Ab + (10)a HIT Ab − (2) HIT Ab NR (12) Median PLT = 160 × 103/mm3 Preop AC: bivalirudin (88%), argatroban (4%), warfarin (4%) | OHT (6) VAD (13) Other (5) | 1 TPE in ORb 1.0 PV plasma | In 11 patients, median preop OD 1.99 → 0.34 after TPE 3 deaths (hemorrhagic stroke, respiratory failure, sepsis) 3 thrombotic events within 7 days of surgery (stroke, DVT, and NR)d |
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | TPE prescription . | Outcomes . |
|---|---|---|---|---|
| Welsby 201012 (11) Retrospective CS | HIT + within 2 wk of surgery (9) HIT + within 2 mo of surgery (2) HIPA − (11) Median preop OD 0.8e (0.7–2.2) | AVR (1) CABG (1) OHT (6) VAD (3) | 1 TPE in ORbc 1.3 PV Plasma | OD ↓50% → 84% 1 patient with left foot loss due to IABP. 3 deaths (3 mos, 6 mos, and 1 year post op) |
| Ramu 201847 (4) Retrospective CS | HIT and SRA + (2); HIT + SRA NR (2) | OHT (1) VAD (2) AVR, MVR (1) | 1 intraop TPE, 4-7 preop TPE | No perioperative thrombosis |
| Moreno Duarte13 (24) Retrospective CS | HIT Ab + (10)a HIT Ab − (2) HIT Ab NR (12) Median PLT = 160 × 103/mm3 Preop AC: bivalirudin (88%), argatroban (4%), warfarin (4%) | OHT (6) VAD (13) Other (5) | 1 TPE in ORb 1.0 PV plasma | In 11 patients, median preop OD 1.99 → 0.34 after TPE 3 deaths (hemorrhagic stroke, respiratory failure, sepsis) 3 thrombotic events within 7 days of surgery (stroke, DVT, and NR)d |
All patients had a history of HIT. Pre-TPE HIT antibody test results were reported in 12 patients.
TPE was done in the OR after the induction of general anesthesia, immediately prior to or after heparinization during cardiopulmonary bypass.
A subset of patients in this study received postoperative TPE. However, this number was not reported.
Two thrombotic events happened before platelet recovery and the third event (NR) after platelet recovery.
In this study, a positive anti-PF4-H OD was >0.4.
Ab, antibody; AC, anticoagulant; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CS, case series; HIPA, heparin-induced platelet aggregation; MVR, mitral valve replacement; NR, not reported; OD, optical density; OHT, orthotopic heart transplant; PLT, platelet count; PV, plasma volume; VAD, ventricular assist device.