Caitlin Raymond: Anticoagulation and TPE: More Nuanced Than You Think!
Caitlin Raymond, a board-certified Clinical Pathologist and current Transfusion Medicine Fellow at the National Institutes of Health, shared on LinkedIn:
”Anticoagulation and TPE: More Nuanced Than You Think
When you see “anticoagulated patient” and “therapeutic plasma exchange (TPE)” in the same sentence, the reflex is clear: they’re going to bleed.
But that’s not always the case.
Over the last few years on service, I’ve learned that the reality is more complicated — and more interesting.
TPE doesn’t interact with all anticoagulants in the same way.
Some are cleared, some aren’t.
Some look scary on paper (hello, post-exchange INR bumps) but don’t consistently translate into bleeding at the bedside.
And antiplatelet agents? Not irrelevant — but not the whole story either.
In this new piece, I walk through:
- Which anticoagulants are actually removed by TPE
- When (and how) to adjust dosing
- How citrate anticoagulation fits into the picture
- What the reversal options look like
- Why short courses are usually safe — and when bleeding risk does rise
The key takeaway: “anticoagulated” doesn’t automatically mean “unsafe.”
The art is knowing which drug, how often, and what else is going on with the patient.
If you’re running TPE, or just want a refresher on how meds and machines collide, I’d love for you to give it a read.”
Read the full post here.
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