Referral pathway for lipoprotein apheresis treatment
Familial hypercholesterolaemia (FH) is considered to be a clinical diagnosis made by an appropriate
clinician. This referral guide is not a replacement for local referral pathways into a lipid clinic.
HoFH = Homozygous familial hypercholesterolaemia
HeFH = Heterzygous familial hypercholesterolaemia
Primary care
Patient identified with FH/severe dyslipidaemia and vascular disease
(See Simon Broome criteria for diagnosis of FH)
Initiate statin therapy and up titrate to the maximum dose
Secondary care
Refer to lipid clinic if inadequate lipid control despite maximally
tolerated dose of high intensity statin.
Lipid Clinic
Add Ezetimibe +/- bile acid sequestrant
If:
-
LDL-C > 5 mmol/L
LDL-C reduction < 40% from baseline
LDL-C > 3.2 mmol/L + Lp(a) > 600 mg/L
LDL-C < 5 mmol/L with aggressive and
progressive vascular disease
Offer referral to local apheresis centre
-
HoFH patients:
- Offer referral to an apheresis unit
- Consider inclusion into an active
clinical trial
- Consider use of Lomitapide