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Intravenous Immunoglobulin (IVIG) use in HIT and efficacy of early IVIG compared to standard of care treatment
Journal article   Open access   Peer reviewed

Intravenous Immunoglobulin (IVIG) use in HIT and efficacy of early IVIG compared to standard of care treatment

Jivtesh Singh, Grace Gorecki, Prabhsimrat Gill, Samantha Maples, Irina Chibisov, Angela Verdoni, Robert A Kaplan, Rama Ganesh, Deep Shah and Arjun Lakshman
Journal of thrombosis and haemostasis, Forthcoming
24 Sep 2026
DOI: https://doi.org/10.1016/j.jtha.2026.09.029
PMID: 42785442
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.1016/j.jtha.2026.09.029View
Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

Thrombocytopenia Intravenous Immunoglobulin Heparin Bleeding Thrombosis
Heparin-induced thrombocytopenia (HIT) is an immune-mediated prothrombotic complication of heparin exposure. Intravenous immunoglobulin (IVIG) has been proposed as an adjunctive therapy for refractory or autoimmune HIT. Real-world utilization patterns and impact of early administration on clinical outcomes remain unclear. We performed a retrospective chart review across the Allegheny Health Network (2015-2025). We described clinical characteristics and outcomes among all HIT patients who received IVIG (n=29). We also compared early IVIG recipients (n=24) to controls (n=129) using 1:2 propensity score matching. The primary outcome was time to platelet recovery, analyzed using Kaplan-Meier estimation and Cox proportional hazards regression. IVIG was used in a cohort of patients with a median platelet count nadir of 26 × 10 /L (IQR of 16 - 35 ×10 /L) and thrombosis was present at diagnosis in 75.8% of patients. Platelet recovery was achieved in 93.1% at a median of 6 days (IQR 3 - 9 Days) days from first dose of IVIG administration, with a favorable safety profile. Early IVIG (within 3 days of HIT diagnosis) was associated with significantly faster platelet recovery in the matched cohort (median 3 vs. 5 days; HR 2.15, 95%CI 1.09-4.26, p=0.028). Higher platelet nadir predicted faster recovery (HR 2.247 per 10 × 10 /L, p < 0.001). No significant differences in thrombosis, bleeding, or mortality were observed. At our institution, IVIG use in HIT was confined to severely ill patients with high thrombotic burden. Early IVIG administration accelerated platelet recovery compared to standard-of-care alone. Prospective multicenter studies are needed to confirm these findings.

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