PMID- 26752590
OWN - NLM
STAT- MEDLINE
DCOM- 20170309
LR  - 20170309
IS  - 1098-1101 (Electronic)
IS  - 0733-2459 (Linking)
VI  - 31
IP  - 6
DP  - 2016 Dec
TI  - Management of systemic unfractionated heparin anticoagulation during therapeutic 
      plasma exchange.
PG  - 507-515
LID - 10.1002/jca.21441 [doi]
AB  - BACKGROUND: Therapeutic plasma exchange (TPE) may remove medications from the 
      patient's plasma. Data is limited on the effect of TPE on unfractionated heparin 
      (UFH). STUDY DESIGN AND METHODS: A retrospective review was performed of patients 
      receiving TPE and continuous IV infusion UFH from 1/1/2008 to 6/30/2010. TPE with 
      plasma or 5% albumin for replacement fluid and pre and post anti-Xa levels within 
      approximately six hours were analyzed. RESULTS: Three patients had 15 TPE with 
      plasma replacement. Anti-Xa levels decreased 47% (mean, -0.25 IU/mL) for two TPE 
      when UFH was not changed, 78% (-0.35 IU/mL) for one TPE when the UFH rate was 
      decreased 25%; and 61% (mean -0.72 IU/mL) for two single volume TPE and 87% 
      (-0.65 IU/mL) for one 1.5 plasma volume TPE when UFH was stopped. During nine 
      TPE, the UFH rate was increased by 65% resulting in a mean increase in the 
      anti-Xa level (mean 0.06 IU/mL, 30%). One patient had five single plasma volume 
      TPE with 5% albumin. Anti-Xa levels decreased when the UFH was not changed (-0.06 
      IU/mL, 38%) and increased when UFH was increased by 30% (0.19 IU/mL, 61%) and 69% 
      (mean 0.04 IU/mL, 15% in three TPE). The PTT increased with all albumin 
      procedures, with more marked increases observed when the UFH rate was increased, 
      while the antithrombin level decreased (mean 65%). CONCLUSION: Heparin was 
      removed from the patient's plasma during TPE. Adjustment of the dose during TPE 
      may be necessary to maintain therapeutic drug levels. Methods for monitoring UFH 
      therapy may not agree. J. Clin. Apheresis 31:507-515, 2016. (c) 2016 Wiley 
      Periodicals, Inc.
CI  - (c) 2016 Wiley Periodicals, Inc.
FAU - Kaplan, Alesia
AU  - Kaplan A
AD  - Department of Laboratory Medicine and Pathology, University of Minnesota, 
      Minneapolis, Minnesota.
FAU - Raut, Prachi
AU  - Raut P
AD  - Department of Laboratory Medicine and Pathology, University of Minnesota, 
      Minneapolis, Minnesota.
FAU - Totoe, Grace
AU  - Totoe G
AD  - Acute Care Medicine, Department of Hospital Medicine, North Memorial Medical 
      Center, Robbinsdale, Minnesota.
FAU - Morgan, Shanna
AU  - Morgan S
AD  - Department of Laboratory Medicine and Pathology, University of Minnesota, 
      Minneapolis, Minnesota.
AD  - American Red Cross, North Central Blood Services, St. Paul, Minnesota.
AD  - Veterans Affairs Medical Center, Minneapolis, Minnesota.
FAU - Zantek, Nicole D
AU  - Zantek ND
AD  - Department of Laboratory Medicine and Pathology, University of Minnesota, 
      Minneapolis, Minnesota.
LA  - eng
PT  - Journal Article
DEP - 20160111
PL  - United States
TA  - J Clin Apher
JT  - Journal of clinical apheresis
JID - 8216305
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/blood/therapeutic use
MH  - Drug Monitoring
MH  - Factor Xa Inhibitors/blood
MH  - Heparin/blood/*therapeutic use
MH  - Humans
MH  - Monitoring, Physiologic
MH  - Plasma Exchange/adverse effects/*methods
MH  - Retrospective Studies
OTO - NOTNLM
OT  - catastrophic antiphospholipid syndrome
OT  - coagulation
OT  - heparin
OT  - plasma exchange
OT  - plasmapheresis
EDAT- 2016/01/12 06:00
MHDA- 2017/03/10 06:00
CRDT- 2016/01/12 06:00
PHST- 2015/07/31 00:00 [received]
PHST- 2015/10/22 00:00 [revised]
PHST- 2015/11/05 00:00 [accepted]
PHST- 2016/01/12 06:00 [pubmed]
PHST- 2017/03/10 06:00 [medline]
PHST- 2016/01/12 06:00 [entrez]
AID - 10.1002/jca.21441 [doi]
PST - ppublish
SO  - J Clin Apher. 2016 Dec;31(6):507-515. doi: 10.1002/jca.21441. Epub 2016 Jan 11.