PMID- 36445851
OWN - NLM
STAT- MEDLINE
DCOM- 20221201
LR  - 20221221
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 23
DP  - 2022 Nov 29
TI  - Therapeutic Plasma Exchange and Supratherapeutic Levels of Unfractionated Heparin 
      in the Management of Critically Ill Patient with Myasthenia Gravis: A Case 
      Report.
PG  - e937617
LID - 10.12659/AJCR.937617 [doi]
AB  - BACKGROUND Therapeutic plasma exchange (TPE) is an extracorporeal method of 
      filtration indicated in several conditions, including myasthenia gravis (MG). The 
      removal and replacement of plasma through TPE affect the level of coagulation 
      factors, suggesting alterations in homeostasis. TPE also has the potential to 
      remove medications from the plasma. Insufficient data are available that evaluate 
      the effect of TPE on certain medications, such as unfractionated heparin (UFH). 
      CASE REPORT We report a case of a 78-year-old woman with MG. She underwent a 
      thymectomy complicated by phrenic nerve injury and respiratory failure, requiring 
      admission to the Intensive Care Unit (ICU) and mechanical ventilation. She 
      developed a provoked left upper extremity deep venous thrombosis and started on 
      therapeutic UFH with a target activated partial thromboplastin time (aPTT) of 50 
      to 80 seconds. Despite being on immunosuppressants, additional therapy with TPE 
      was deemed necessary for her MG exacerbation. Therefore, she received 5 sessions 
      of TPE, given every other day. Interestingly, while on TPE therapy, the aPTT 
      increased significantly after each administration, with TPE reaching >170 seconds 
      in some instances. As a precautionary measure, heparin infusion was held for 1 
      day based on the institutional heparin protocol and the physician's decision. 
      Fortunately, the patient did not develop any bleeding complications. CONCLUSIONS 
      TPE treatment may temporarily deplete the coagulation factors, leading to 
      supratherapeutic aPTT levels. UFH dose adjustment and frequent assessment of aPTT 
      levels are essential during TPE treatment to minimize serious bleeding 
      complications. Future studies with a larger sample size are required to focus on 
      understanding the effect of TPE on medications.
FAU - Alshehri, Shaden D
AU  - Alshehri SD
AUID- ORCID: 0000-0001-7161-7735
AD  - College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, 
      Riyadh, Saudi Arabia.
AD  - King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
FAU - Al Sulaiman, Khalid
AU  - Al Sulaiman K
AUID- ORCID: 0000-0002-5547-2043
AD  - College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, 
      Riyadh, Saudi Arabia.
AD  - King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
AD  - Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint 
      Abdulrahman University, Riyadh, Saudi Arabia.
AD  - Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi 
      Arabia.
AD  - Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia.
FAU - Aljuhani, Ohoud
AU  - Aljuhani O
AD  - Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia.
FAU - Al Harbi, Shmeylan A
AU  - Al Harbi SA
AD  - College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, 
      Riyadh, Saudi Arabia.
AD  - King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
AD  - Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi 
      Arabia.
FAU - Alalawi, Mai
AU  - Alalawi M
AUID- ORCID: 0000-0002-3491-5685
AD  - Department of Pharmaceutical Sciences, Fakeeh College of Medical Sciences, 
      Jeddah, Saudi Arabia.
FAU - Alenazi, Abeer A
AU  - Alenazi AA
AD  - Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, 
      Saudi Arabia.
FAU - Kensara, Raed
AU  - Kensara R
AD  - King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
AD  - Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi 
      Arabia.
FAU - Alshaya, Omar A
AU  - Alshaya OA
AD  - College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, 
      Riyadh, Saudi Arabia.
AD  - King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
AD  - Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi 
      Arabia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20221129
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Female
MH  - Humans
MH  - Aged
MH  - *Plasma Exchange
MH  - Heparin/therapeutic use
MH  - Critical Illness/therapy
MH  - Plasmapheresis
MH  - *Myasthenia Gravis/drug therapy
PMC - PMC9724441
COIS- Conflict of interest: None declared
EDAT- 2022/11/30 06:00
MHDA- 2022/12/02 06:00
PMCR- 2022/11/29
CRDT- 2022/11/29 13:22
PHST- 2022/11/29 13:22 [entrez]
PHST- 2022/11/30 06:00 [pubmed]
PHST- 2022/12/02 06:00 [medline]
PHST- 2022/11/29 00:00 [pmc-release]
AID - 937617 [pii]
AID - 10.12659/AJCR.937617 [doi]
PST - epublish
SO  - Am J Case Rep. 2022 Nov 29;23:e937617. doi: 10.12659/AJCR.937617.