PB1452 - Hemorrhagic and thrombotic complications in patients receiving therapeutic plasma exchange

Background: A predictable consequence of therapeutic plasma exchange (TPE) is the removal of coagulation proteins and disruption of the hemostatic milieu. The impact of this coagulopathy on clinical outcomes is unclear.

Aims: This study aimed to determine the cumulative incidence of hemorrhagic and thrombotic complications in patients undergoing TPE and assess clinical practice patterns regarding antiplatelet and anticoagulant management in this population.

Methods: We performed a retrospective cohort study of patients treated with TPE at Beth Israel Deaconess Medical Center from 2017 to 2021. Patients were included if they received three or more TPE sessions during a 14-day period. The study excluded patients who required full plasma replacement as a matter of protocol including those with diffuse alveolar hemorrhage, thrombotic thrombocytopenic purpura, and humoral transplant rejection. The study period was from the first TPE session and ended 30 days after the final session. Hemorrhagic and thrombotic events were reviewed manually by two independent reviewers and categorized based on ISTH guidelines.

Results: The cohort was comprised of 176 patients and a total of 890 TPE procedures. 74 (42%) patients developed a prolonged prothrombin time and 58 (33%) developed a prolonged partial thromboplastin time on at least one occasion. Eighteen patients experienced a bleeding event (10.2%; 95% CI 6.1-15.7%), and 7 patients experienced a thrombotic event (4.0%; 95% CI 1.6-8.0%) (Figure 1). The cumulative incidence of major bleeding was 3.4% (95% CI 1.3-7.3%), and one bleeding event was fatal (Table 1). Nine of 41 patients (22%) with prior antiplatelet use and one of 13 patients (7.4%) with prior anticoagulation use had temporary discontinuation of the medication during the treatment period.

Conclusion(s): Derangements in coagulation parameters and rates of bleeding and thrombosis in the first 30 days of patients receiving TPE are substantial and merit further study to better characterize risk factors and preventive strategies.