Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature

Abstract

Our study demonstrates that IvIg-related thrombotic arterial/venous complications are not uncommon in patients with autoimmune disorders (13% of patients). Nevertheless, patients, who are followed up in Departments of Internal Medicine often have concomitant disorders placing them at increased risk to develop IvIg-related thrombotic complications; the latter may also explain the high rate of IvIg-related thrombosis in our cohort. Our series further indicates that patients should be monitored closely for these types of adverse events during the whole period of IvIg therapy, as thrombotic manifestations occurred in patients who had received multiple IvIg infusions without exhibiting complications. In addition, our results suggest that it is questionable to initiate IvIg therapy in patients presenting with predictive factors of thrombotic complications; in this subgroup of patients, IvIg should be prescribed cautiously, after re-weighing risk-benefit considerations.

Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study

“…[29][30][31][32][33] Studies with different therapies that increase platelets in these patients through various mechanisms have reported TEEs, including IVIg, 34 corticosteroids, 35 anti-CD40 ligand, 36 and other TPO-R agonists. 37 Approximately 3% of patients had experienced TEEs before entering the eltrombopag ITP trials.…”

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

“…13,14,[24][25][26][27][28][29][30][31][32] However, the extent to which these events are attributable to the IVIg itself rather than other risk factors is unclear, as is the risk associated with low doses of IVIg for immunodeficiency. In this retrospective cohort study, we assessed rates of clinically serious arterial and venous TEEs in older patients with CLL or MM who initiated IVIg therapy.…”

Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides: A French Nationwide Study of Ninety‐Two Patients

“…To minimize adverse events, caution should be taken, and since advanced age is the major risk factor for venous thromboembolism (38,39), the risk/benefit ratio should be carefully evaluated in this population. IVIG should probably be avoided if the estimated glomerular filtration rate is ,30 ml/minute/1.73 meter 2 , with plasma exchanges being a likely beneficial alternative if an adjunctive therapy is needed (40).…”