The use of therapeutic apheresis in cardiovascular disease

Area of Science:

• Cardiovascular Medicine
• Immunology
• Hematology

Background:

• Therapeutic apheresis (TA) is increasingly recognized for treating cardiovascular diseases (CVDs) and cardiac dysfunctions linked to autoimmune or metabolic disorders.
• Established indications include familial hypercholesterolemia, hyperviscosity syndrome, and thrombotic thrombocytopenic purpura (TTP).

Purpose of the Study:

• To review novel applications of TA in dilated cardiomyopathy, cardiac failure, and post-heart transplant dysfunction.
• To highlight the immune-modulating benefits of TA in these cardiovascular conditions.
• To discuss the efficacy and safety of TA in established and emerging indications.

Main Methods:

• Review of current literature on therapeutic apheresis applications in cardiovascular medicine.
• Analysis of established indications like familial hypercholesterolemia, hyperviscosity syndrome, and TTP.
• Exploration of emerging uses in dilated cardiomyopathy, cardiac failure, and post-transplant scenarios.

Main Results:

• Therapeutic plasma exchange has significantly improved TTP outcomes.
• Low-density lipoprotein apheresis is highly effective and safe for long-term cholesterol reduction.
• Plasma exchange efficiently reduces blood viscosity in hyperviscosity syndromes, mitigating cardiac risks.
• TA may induce oxidative stress in erythrocytes, potentially necessitating antioxidant therapies like ascorbate.

Conclusions:

• TA presents promising therapeutic avenues for various cardiovascular conditions, particularly those with autoimmune or metabolic origins.
• While established indications show clear benefits, novel applications require further clinical investigation and validation.
• Optimizing TA protocols, potentially including antioxidant strategies, may enhance patient outcomes and mitigate side effects.