Identification and management of FH full guideline
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NICE guidance on LDL Apheresis

Statements on LDL-apheresis from NICE Guidance on FH

8.1.1 Specialist interventions - LDL Apheresis and transplantation

Individuals with homozygous FH and, in exceptional circumstances, those with heterozygous FH may need additional, specialist treatments if drug treatment is not able to achieve the necessary LDL-C lowering.

LDL Apheresis is a mechanical method of removing LDL-C from the blood, similar to that used for kidney dialysis. It is a process that needs to be undertaken approximately every two weeks and requires specialist administration and monitoring.

Research recommendations

1.8.3 LDL apheresis for people with heterozygous FH

What are the appropriate indications, effectiveness and safety of LDL apheresis in people with heterozygous FH?

Why this is important

There is limited evidence to inform specific indications for LDL apheresis in people with heterozygous FH. In addition, there is limited published evidence on the cardiovascular outcome of such patients treated with LDL apheresis.

Evidence on the value of investigations (various measures of vascular status, considered to reflect the extent or activity of atherosclerotic vascular disease of the coronary arteries) in predicting outcome from LDL apheresis should ideally be based on evidence from randomised controlled trials with clinical outcomes. It is difficult to identify a suitable alternative treatment because LDL apheresis is generally only considered in people for whom no other treatment is available. One comparator may be novel therapies with antisense oligonucleotides (ApoB).