Journal article
Effectiveness of intravenous immunoglobulin use in heparin-induced thrombocytopenia
Blood coagulation & fibrinolysis, v 31(5), pp 287-292
01 Jul 2020
PMID: 32398463
Abstract
Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and nonheparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin (IVIg) have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the published literature on use of IVIg in the treatment of HIT. A systematic search of PubMed, Google Scholar, EMBASE and SCOPUS for all study designs and reports were carried out from inception until April 2019. Statistical analysis was done using Microsoft Excel and Stata version 13. In 34 patients with HIT, the mean age was 60 years. About 70% cases were by unfractionated heparin exposure and 30% by low-molecular weight heparin. The most common precipitant in the patients without heparin exposure was recent surgery. Average nadir platelet count for which IVIg was used was 28 000/mu l. Time from resolution of the thrombocytopenia after IVIg treatment was 3 days with average platelet count recovery to 159 000/mu l. Mean time from diagnosis to administration of IVIg was day 18. Thrombosis was identified in 32% of patients. About 77% patients improved (platelet count >100 000/mu l or cessation of thrombosis) following use of IVIg. Logistic regression did not identify any factors that predicted IVIg response (P > 0.05). No thrombotic events or other adverse events were noted with use of IVIg. IVIg appears to be a safe and effective treatment option for HIT-related thrombocytopenia and for refractory thrombosis.
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Details
- Title
- Effectiveness of intravenous immunoglobulin use in heparin-induced thrombocytopenia
- Creators
- Madan R. Aryal - Roswell Park Comprehensive Cancer CenterRohit Gosain - Roswell Park Comprehensive Cancer CenterAnthony Donato - Reading HospitalAnjan Katel (Corresponding Author) - Kathmandu UniversityRikesh Chakradhar - University of Kansas Medical CenterRashmi Dhital - Reading HospitalPeter A. Kouides - Unity Health System
- Publication Details
- Blood coagulation & fibrinolysis, v 31(5), pp 287-292
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); General Internal Medicine
- Web of Science ID
- WOS:000561254800001
- Scopus ID
- 2-s2.0-85088392444
- Other Identifier
- 991022161832504721