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Treatment with or without plasma exchange for patients with acquired thrombotic microangiopathy not associated with severe ADAMTS13 deficiency: a propensity score–matched study
Author(s) -
Li Ang,
Makar Robert S.,
Hurwitz Shelley,
Uhl Lynne,
Kaufman Richard M.,
Stowell Christopher P.,
Dzik Walter S.,
Bendapudi Pavan K.
Publication year - 2016
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13654
Subject(s) - adamts13 , medicine , thrombotic thrombocytopenic purpura , thrombotic microangiopathy , propensity score matching , confidence interval , hazard ratio , odds ratio , gastroenterology , platelet , disease
BACKGROUND Therapeutic plasma exchange (TPE) is a proven treatment for thrombotic thrombocytopenic purpura (TTP) characterized by severe ADAMTS13 deficiency, but the efficacy of TPE in suspected TTP with an ADAMTS13 activity level of more than 10% remains controversial. STUDY DESIGN AND METHODS We conducted a propensity score (PS)‐matched study of 186 adult patients included in the Harvard Thrombotic Microangiopathy (TMA) Research Collaborative registry who presented with TMA suggestive of TTP but an ADAMTS13 activity level of more than 10%. RESULTS Before matching, patients treated with TPE (n = 71) differed from untreated patients (n = 115) by several clinical measures. PS matching was performed to address clinical disparities between the two groups and resulted in a well‐balanced cohort of 59 TPE‐treated patients paired with 59 untreated controls, all of whom had TMA. After matching, we observed no significant difference in the primary outcome of 90‐day survival between the treated and untreated groups (hazard ratio, 0.88; 95% confidence interval [CI], 0.44‐1.77; p = 0.72). In‐hospital mortality (odds ratio [OR], 0.77; 95% CI, 0.34‐1.75; p = 0.53) and the percentage of patients with platelet count recovery (OR, 1.58; 95% CI, 0.77‐3.26; p = 0.21) also did not differ significantly between the two matched groups. CONCLUSION Our data suggest that routine use of TPE in the diverse group of TMA patients without severe ADAMTS13 deficiency may not significantly improve outcomes.