Plasmapheresis has been associated with successful treatment outcomes in uncontrolled studies of patients with severe HIT (Vender et al., 1986; Bouvier et al., 1988; Nand and Robinson, 1988; Manzano et al., 1990; Thorp et al., 1990; Brady et al., 1991; Poullin et al., 1998). Whether this is due to removal of HIT antibodies or pathogenic immune complexes, or even correction of acquired natural anticoagulant deficiencies by normal plasma replacement, is unresolved. For example, a patient with warfarin-induced acquired protein C deficiency and severe venous limb ischemia may have benefited from correction of the protein C deficiency with apheresis using plasma replacement (Warkentin et al., 1997).

Recommendation. Plasmapheresis, using plasma as replacement fluid, may be a useful adjunctive therapy in selected patients with acute HIT and life- or limb-threatening thrombosis who are suspected or proved to have acquired deficiency of one or more natural anticoagulant proteins (grade 2C).

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