Therapie des Heparin-induzierten Thrombose-Thrombozytopenie-Syndroms mit Immunglobulinen

Prull, A.; Nechwatal, Robert; Riedel, Hannah; Mäurer, W

doi:10.1055/s-2008-1062518

Cited by 16 publications

(9 citation statements)

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“…We identified 20 reports in the literature describing 27 cases of acute HIT that were treated with IVIG (Table ) . Two cases of putative HIT were excluded, one because the clinical picture was not sufficiently specific for HIT, and no testing for HIT antibodies was performed, and the other because IVIG was given for treatment of Group A puerperal toxic shock syndrome, with associated severe sepsis‐associated thrombocytopenia and with possible HIT only developing several days later, with prompt PLT count recovery after stopping heparin; thus, the impact of IVIG administration, if any, on PLT count changes in HIT could not be ascertained .…”

Section: Resultsmentioning

confidence: 99%

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

et al. 2019

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BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder characterized by heparindependent antibodies that activate platelets (PLTs) via PLT FcγIIa receptors. "Autoimmune" HIT (aHIT) indicates a HIT subset where thrombocytopenia progresses or persists despite stopping heparin; aHIT sera activate PLTs strongly even in the absence of heparin (heparin-independent PLTactivating properties). Affected patients are at risk of severe complications, including dual macro-and microvascular thrombosis leading to venous limb gangrene. High-dose intravenous immunoglobulin (IVIG) offers an approach to interrupt heparin-independent PLT-activating effects of aHIT antibodies. CASE REPORT:A 78-year-old male who underwent cardiopulmonary bypass for aortic dissection developed aHIT, disseminated intravascular coagulation, and deep vein thrombosis; progression to venous limb gangrene occurred during partial thromboplastin time (PTT)-adjusted bivalirudin infusion (underdosing from "PTT confounding"). Thrombocytopenia recovered with high-dose IVIG, although the PLT count increase began only after the third dose of a 5-day IVIG regimen (0.4 g/kg/day × 5 days). We reviewed case reports and case series of IVIG for treating HIT, focusing on various IVIG dosing regimens used. RESULTS: Patient serum-induced PLT activation wasinhibited in vitro by IVIG in a dose-dependent fashion; inhibition of PLT activation by IVIG was much more marked in the absence of heparin versus the presence of heparin (0.2 U/mL). Our literature review indicated 1 g/kg × 2 IVIG dosing as most common for treating HIT, usually associated with rapid PLT count recovery. CONCLUSION:Our clinical and laboratory observations support dose-dependent efficacy of IVIG for decreasing PLT activation and thus correcting thrombocytopenia in aHIT. Our case experience and literature review suggests dosing of 1 g/kg IVIG × 2 for patients with severe aHIT. ABBREVIATIONS: aHIT = autoimmune heparin-induced thrombocytopenia; DIC = disseminated intravascular coagulation; DVT = deep vein thrombosis; HIT = heparin-induced thrombocytopenia; ITP = idiopathic thrombocytopenic purpura; PE = pulmonary embolism; PF4 = platelet factor 4; POD = postoperative day; PTT(s) = partial thromboplastin time(s); SRA = serotonin release assay; UFH = unfractionated heparin. From the

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Section: Resultsmentioning

confidence: 99%

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

et al. 2019

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“…There were 15 additional cases (10 articles; additional to the cases identified in Tables 2 and 3) published describing IVIG use for treatment of suspected HIT. [45][46][47][48][49][50][51][52][53][54] Two cases were published in German. 47,48 In 1989, Frame et al reported the first case using IVIG for suspected HIT.…”

Section: Case Reports Using Ivig That Did Not Meet Inclusion Criteriamentioning

confidence: 99%

“…[45][46][47][48][49][50][51][52][53][54] Two cases were published in German. 47,48 In 1989, Frame et al reported the first case using IVIG for suspected HIT. 45 Frame et al 45 and 7 additional cases did not report a HIT immunoassay or activation assay at the time of HIT diagnosis.…”

Section: Case Reports Using Ivig That Did Not Meet Inclusion Criteriamentioning

confidence: 99%

Intravenous Immune Globulin (IVIG) for Treatment of Autoimmune Heparin-Induced Thrombocytopenia: A Systematic Review

Dougherty

Yarsley

2020

Ann Pharmacother

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Objective: To evaluate intravenous immune globulin (IVIG) for autoimmune heparin-induced thrombocytopenia (aHIT), including platelet recovery, IVIG dose, dosing weight, IVIG product used, and complications reported. Data Sources: PubMed and EMBASE were searched from inception through June 21, 2020. Search terms included heparin-induced thrombocytopenia, HIT, intravenous immune globulin, IVIG, autoimmune HIT, aHIT, and immune globulin. Study Selection and Data Extraction: Patients administered IVIG for HIT and diagnosed by immunoassay (optical density ≥2) or positive activation assay were included. Data Synthesis: Twenty-four cases were reviewed; 92% had persistent aHIT. Time to IVIG administration post–nonheparin anticoagulant initiation was 9 days (median). Most common IVIG cumulative dose was 2 g/kg (dosed as 1 g/kg/d for 2 consecutive days); 75% had a favorable platelet increase (≥50 × 109/L) within 5 days of initial IVIG dosing. Relevance to Patient Care and Clinical Practice: aHIT is characterized by critically low platelets, thrombosis, and a persistent delay in platelet recovery despite treatment with a nonheparin anticoagulant. An immunoassay and subsequent confirmatory activation assay (at low, high, and 0 IU/mL unfractionated heparin levels) is recommended to confirm diagnosis. Patients nonresponsive to nonheparin anticoagulants within 5 days of initiation should be evaluated for IVIG treatment (2 g/kg cumulative dose). More data are needed to clarify appropriate IVIG dosing weight, although based on current published literature, it is recommended to use actual body weight. Conclusions: Data reported support use of IVIG as adjunctive therapy for patients with aHIT. Judicious IVIG use based on key clinical and laboratory findings is critical.

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“…A total of 11 cases have been identified in the literature [16][17][18][19][20][21][22][23][24] showing the efficiency of treating HIT by IVIG (Table I). Interestingly, eight out of eleven patients were female.…”

Section: Solving Clinical Problems In Blood Diseasesmentioning

confidence: 99%

Severe and persistent heparin‐induced thrombocytopenia despite fondaparinux treatment

Tvito

Bakchoul²,

Rowe

et al. 2015

American J Hematol

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Therapie des Heparin-induzierten Thrombose-Thrombozytopenie-Syndroms mit Immunglobulinen

Cited by 16 publications

References 0 publications

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

Intravenous Immune Globulin (IVIG) for Treatment of Autoimmune Heparin-Induced Thrombocytopenia: A Systematic Review

Severe and persistent heparin‐induced thrombocytopenia despite fondaparinux treatment

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