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- Title
A lower fibrinogen threshold does not lead to increased bleeding risk in patients receiving therapeutic plasma exchange: A prospective single‐center analysis.
- Authors
Wodajo, Amelework; Sarode, Ravi; Valiyaparambil, Shiney; Webb, Christopher; De Simone, Nicole; Rebecca, Dill; Usmani, Amena
- Abstract
Background: Plasma exchange (PLEX) therapy is indicated for several disorders. The 5% albumin is often used as a sole replacement fluid during most PLEX. However, each 1.0 plasma volume exchange depletes coagulation factors by ~65%. Although most coagulation factors recover to hemostatic levels within 24 h post‐PLEX, fibrinogen requires 48–72 h to recover. Fibrinogen is the key coagulation protein for hemostasis. Therefore, fibrinogen is often monitored during the acute course of PLEX, and plasma is supplemented to prevent bleeding if fibrinogen is <100 mg/dL. Study Design and Methods: We conducted a prospective, single‐center, observational study to evaluate bleeding risk in adults who received an acute course of PLEX with a fibrinogen level of 80–100 mg/dL without plasma supplementation during the procedure or before central venous catheter removal. The study group was compared to patients with plasma fibrinogen >100 mg/dL. Results: Among the 275 patients who received 1406 PLEXes, 62 patients (23%) who underwent 323 PLEXes met the inclusion criteria, and only 2 (3%) patients had bleeding while on oral anticoagulants. In contrast, out of 275 patients, 143 (52%) with fibrinogen levels >100 mg/dL received 751 PLEX treatments, and bleeding occurred in 2 (1%) while on low‐molecular‐weight heparin. Conclusions: Our findings suggest that a pre‐procedure fibrinogen threshold of 80–100 mg/dL without plasma supplementation does not increase bleeding risk unless patients were on anticoagulation. See editorial on page 959–962, in this issue
- Subjects
PLASMA exchange (Therapeutics); FIBRINOGEN; BLOOD coagulation factors; LOW-molecular-weight heparin; ORAL medication; THROMBELASTOGRAPHY
- Publication
Transfusion, 2024, Vol 64, Issue 6, p1076
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/trf.17865