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Study Design and Methods: Patients with thrombotic microangiopathy codes were identified in a retrospective cross-sectional analysis using public data from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III), assessing linearity between time to therapy and bleeding, thrombosis, and mortality, then estimating an optimal time via nonparametric bootstrapping. Results: For 149 patients, the association was non-linear, with low predictive capacity (AUC 0.62); maximal outcomes occurred at 13.5 h. Conclusion: Time to therapeutic plasma exchange did not independently predict outcome; future studies should evaluate interactions with other variables.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/in-patients-with-suspected-thrombotic-thrombocytopenic-purpura-what-is-the-optimal-time-to-therapeutic-plasma-exchange/417965/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/in-patients-with-suspected-thrombotic-thrombocytopenic-purpura-what-is-the-optimal-time-to-therapeutic-plasma-exchange/417965.png","ImageObject",300,407,{"name":92,"@type":93},"Oliver","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment timing does current guidance recommend for suspected immune TTP?","Question",{"text":112,"@type":113},"Guidelines recommend initiating therapeutic plasma exchange within eight hours of suspected diagnosis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the optimal time to therapeutic plasma exchange estimated in this study?",{"text":117,"@type":113},"The study used a retrospective cross-sectional analysis of REDS-III public data, evaluated time-outcome relationships, and identified the optimal time via a nonparametric approach with bootstrapping.",{"name":119,"@type":110,"acceptedAnswer":120},"What optimal time maximized outcomes according to the results?",{"text":121,"@type":113},"The time associated with maximal outcomes was 13.5 hours.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},417965,1790758730,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},8796095461610,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","hematol transfus cell ther. 2026;48(1):106223  \nHematology, Transfusion and Cell Therapy  \n[www. htct. com. br](www. htct. com. br)  \n| Original article |  |  |  |\n| --- | --- | --- | --- |\n| In patients with suspected thrombotic thrombocytopenicpurpura, what is the optimal time to therapeutic plasma exchange? |  |  | |\n| Alexandre Soares Ferreira Junior  a,b, Kate Sanborn  c, Morgana Pinheiro Maux Lessa a, Alexander Gordeed,\u003Cbr>Maragatha Kuchibhatlad, Allison O. Taylor  e, Matthew S. Karafinf, OluwatoyosiA. Onwuemene  e,*\u003Cbr>a Department of Medicine, Faculdade de Medicina de S~ao Jos do Rio Preto, S~ao Jos do Rio Preto, S~ao Paulo, Brazil b General and Applied Biology Program, Institute of Biosciences, Sao Paulo State University, Botucatu, Brazil c Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, NC, USA d Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA e Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USAf Department of Pathology and Laboratory Medicine, University of NC, Chapel Hill, NC, USA |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Article history:\u003Cbr>Received 27 February 2025 Accepted 22 September 2025 Available online xxx |  | Background: In patients with suspected immune thrombotic thrombocytopenic purpura, guidelines suggest that therapeutic plasma exchange should be initiated within eight hours. However, this time threshold may be difficult to attain. This study sought to identify the optimal time to plasma exchange to maximize outcomes.\u003Cbr>Study Design and Methods: Patients with international classification of disease codes for thrombotic microangiopathy were identified in a retrospective cross-sectional analysis of public use data files from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). The assumption of linearity between time to therapeutic plasma exchange and the composite outcome of bleeding, thrombosis, and mortality were evaluated. Subsequently, the optimal time for plasma exchange was identified using a nonparametric approach with bootstrapping. Results: For 149 patients with a suspected diagnosis of thrombotic thrombocytopenic purpura, the association between time to plasma exchange and the primary outcome was non-linear. With regard to the primary composite outcome, this time had a low predictive capacity (area under the curve: 0.62). The optimal time that maximized outcomes was 13.5 h.\u003Cbr>Conclusion: Although this study found that time to therapeutic plasma exchange did not independently predict outcome, future studies might evaluate how this time interacts with other variables to predict clinical outcomes.\u003Cbr>Published by Elsevier España, S.L.U. on behalf of Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). |  |\n| Keywords: ADAMTS13\u003Cbr>Hemostasis Plasmapheresis\u003Cbr>Thrombotic thrombocytopenicpurpura\u003Cbr>Thrombocytopenia |  |  |  |\n\n* Corresponding author at: 40 Duke Medicine Circle, DUMC Box 3422, Durham, NC 27710 .  \nE-mail address: [toyosi.onwuemene@duke.edu](toyosi.onwuemene@duke.edu) (O.A. Onwuemene).  \n[https://doi.org/10.1016/j.htct.2025.106223](https://doi.org/10.1016/j.htct.2025.106223)  \n2531-1379/Published by Elsevier España, S.L.U. on behalf of Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. This isan open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)).  \nIntroduction  \nIn patients with suspected thrombotic thrombocytopenic purpura (TTP), therapeutic plasma exchange (TPE) and immunosuppression should be initiated promptly [1] . Although prompt TPE initiation has been associated with improved outcomes of thrombosis, major bleeding, and mort","cbCaiqTs7Nn2IeNm","https://ap.wps.com/l/cbCaiqTs7Nn2IeNm","pdf",600045,"English","# Article history\n## Background\n## Study Design and Methods\n## Results\n## Conclusion\n## Keywords\n## Introduction\n## Methods\n### Study design and data source","[{\"question\":\"What treatment timing does current guidance recommend for suspected immune TTP?\",\"answer\":\"Guidelines recommend initiating therapeutic plasma exchange within eight hours of suspected diagnosis.\"},{\"question\":\"How was the optimal time to therapeutic plasma exchange estimated in this study?\",\"answer\":\"The study used a retrospective cross-sectional analysis of REDS-III public data, evaluated time-outcome relationships, and identified the optimal time via a nonparametric approach with bootstrapping.\"},{\"question\":\"What optimal time maximized outcomes according to the results?\",\"answer\":\"The time associated with maximal outcomes was 13.5 hours.\"}]","In patients with suspected thrombotic thrombocytopenic purpura, what is the optimal time to therapeutic plasma exchange? | PDF",1790611399,18]