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Venous thromboembolism associated with the management of acute thrombotic thrombocytopenic purpura
Author(s) -
Yarranton Helen,
Cohen Hannah,
Pavord Sue R.,
Benjamin Sylvia,
Hagger Diana,
Machin Samuel J.
Publication year - 2003
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.2003.04360.x
Subject(s) - medicine , thrombotic thrombocytopenic purpura , thrombosis , venous thrombosis , venous thromboembolism , thrombophilia , low molecular weight heparin , gastroenterology , deep vein , risk factor , pulmonary embolism , platelet , surgery
Summary. Venous thromboembolism (VTE) is not a feature of thrombotic thrombocytopenic purpura (TTP), but there has been a recent report of VTE in association with plasma exchange (PEX) treatment for TTP using the solvent detergent (SD) plasma, PLAS+ ® SD. We reviewed the occurrence of VTE in 68 consecutive patients with TTP (25 men, 43 women). Eight documented VTE events [six deep venous thromboses (DVTs), three pulmonary emboli] were identified in seven patients (all female) during PEX therapy. All six DVTs were associated with central lines at the site of thrombosis. Other known precipitating factors included pregnancy, immobility, obesity and factor V Leiden heterozygosity. VTE occurred at a mean of 53 d following the first PEX. The European SD plasma, Octaplas ® was the last plasma to be used in PEX prior to the VTE in 7/8 events. This is the first report of VTE following Octaplas ® infusion. VTE is a multifactorial disease and, although several known precipitating factors were present in all patients in this study, the use of large volumes of SD plasma in PEX may be an additional risk factor. We recommend prevention of VTE with graduated elastic compression stockings (class I) at diagnosis and prophylactic low‐molecular‐weight heparin once the platelet count rises above 50 × 10 9 /l.