099 Thrombotic and haemorrhagic complications associated with PLEX, reducing the risks. Issue 9 (12th August 2022)

• Record Type: Journal Article
• Authors: Japzon, Nicole; Han, Ruth; Sacks, Benjamin; Levee, Viva; Rosser, Sinead; Samaroo, Yasmine; Westwood, John Paul; Zambreanu, Laura; Lunn, Michael P; Spillane, Jennifer
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 9(2022)
• Page Start: e2
• Publication Date: 2022-08-12
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-abn2.143
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Plasma Exchange (PLEX) is an increasingly used therapy for various immune-mediated neu- rological diseases. Treatment can be complicated by potentially life-threatening clots and bleeds but there is limited data available regarding these risks. Method and Intervention: A retrospective audit of the records of patients receiving PLEX in the NHNN for neurological disease from May 2019 – October 2020 was performed to identify thrombotic and haemor- rhagic complications. A multi-disciplinary PLEX working group was created to set guidelines for all aspects of the PLEX process including mode of vascular access, use of prophylactic heparin and fluid replace- ment. The service was subsequently re-audited. Results: 46 patients were treated with plasma exchange between May 2019 and Oct 2020. 11% developed a thrombus requiring anticoagulation. 41% developed a haemorrhage, 42% of which required intervention. Following protocol change a review of 32 patients between November 2020 to October 2021 showed that there was a reduction of 27% in the incidence of thrombus and a 17% reduction in the incidence of haemorrhage. Conclusion: PLEX is integral to the treatment of disabling and potentially fatal immune-mediated neuro-logical diseases. Careful consideration of all aspects of the PLEX process, reduces risks associated with treatment and improves patient safety.