Abstract
In high bleeding risk patients undergoing therapeutic plasma exchange (TPE), the optimal hemostasis testing strategy is not known. Therefore, in a cohort of patients with a major bleeding event prior to TPE, we sought to describe hemostasis testing practices. In a cross-sectional analysis of the Recipient Epidemiology and Donor Evaluation Study-III public use data files, we identified patients with bleeding prior to TPE initiation. Within two days prior to TPE initiation, we assessed performance of any of the following tests: Platelet count, International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT), and Fibrinogen. Results were stratified by bleeding recurrence status (Yes vs No recurrence). Bleeding recurrence after TPE was defined as a major bleeding event occurring within two days of a TPE procedure. Among 310 patients meeting inclusion criteria, hemostasis tests were done in 298 (96%). For all patients, the most common hemostasis test was the platelet count (95%). The least common was fibrinogen (36%). Among the Yes recurrence (No.=121) and No recurrence (n=189) cohorts, the most common test combinations were Platelet + INR (68% and 77%, respectively) and Platelet + INR + aPTT (78% and 71%, respectively). Across both cohorts, all four hemostasis tests were assessed in 33% and 22%, respectively. In patients with bleeding prior to TPE, hemostasis tests are assessed inconsistently. The effectiveness of hemostasis testing in both identifying and mitigating bleeding risk should be assessed in future studies.
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