Intravenous immunoglobulin–associated thrombosis: is it such a rare event? Report of a pediatric case and of the <scp>Q</scp>uebec <scp>H</scp>emovigilance <scp>S</scp>ystem

Benadiba, Joy; Robitaille, Nancy; Lambert, Gilles; Itaj, Nawej Karl; Pastore, Yves D.

doi:10.1111/trf.12897

Cited by 21 publications

(13 citation statements)

References 17 publications

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“…One patient presented cerebral thrombophlebitis after IVIg, which was extended after another IVIg infusion despite AC treatment, with a fatal result. Thrombotic events after IVIg are rare in large databases, but our findings and some previous reports, sometimes with death, suggest that physicians should be vigilant regarding the possibility of thrombotic complications with IVIg infusion, particularly in patients with a past history of a VTE.…”

Section: Discussionmentioning

confidence: 46%

Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study

Guenno

Guièze

Audia³

et al. 2019

Internal Medicine Journal

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Background: An increased risk of thrombosis has been reported in immune thrombocytopenic purpura (ITP), but the characteristics, risk factors of occurrence, recurrence and management of venous thromboembolic events (VTE) have been poorly investigated.Aims: To describe VTE and ITP characteristics, distribution of VTE risk factors and their impact on VTE features and recurrence.Methods: A retrospective study of patients with ITP and VTE registered in databases of three reference French centres of ITP.Results: Among 49 patients, 66 VTE were recorded. The platelet count at the time of the first VTE was <100 × 10 9 /L for 28/43 (65%) patients. In total, 19/48 (40%) patients had at least one positive antiphospholipid test result. For the 10 VTE occurring in eight patients with platelet count <50 × 10 9 /L, ITP treatment was efficient in 7. One haemorrhagic complication associated with anticoagulant (AC) therapy was recorded. For 31/49 (63%) patients, long-term AC therapy could have been discussed after the first VTE, but only 13 received it. A second VTE occurred in 13 (27%) patients. The risk of recurrence was increased in patients with unprovoked VTE before ITP diagnosis or active cancer.Conclusion: VTE in ITP mainly occurred in the presence of multiple risk factors of TE.A low platelet count does not protect against VTE. Management with AC therapy despite persistently low platelet count seems possible. Risk of VTE recurrence is high, particularly with a history of unprovoked VTE or active cancer. In this setting, indefinite AC therapy could be discussed.

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Section: Discussionmentioning

confidence: 46%

Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study

Guenno

Guièze

Audia³

et al. 2019

Internal Medicine Journal

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“…Meta‐analysis of three studies revealed an increased rate of VOD in recipients receiving IVIG. Thromboembolic events have been reported to be associated with IVIG presumably due to a hypercoagulable state, although a recent meta‐analysis did not confirm such an association . Thrombotic events are usually associated with high doses and rapid administration of IVIG .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of immunoglobulin prophylaxis in reducing clinical complications of hematopoietic stem cell transplantation: a systematic review and meta‐analysis

et al. 2018

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“…The main findings in the literature on this topic are shown in ►Table 1. [64][65][66][67][68][69][70][71][72][73][74] Despite the inconclusive evidence, in 2002 the U.S. Food and Drug Administration required an updated package labeling for Ig to include a warning about the risk of thrombotic events. 75 Taking into account these limitations, the reported incidence of thrombotic events varies from 3 to 13%.…”

Section: Intravenous Immunoglobulinsmentioning

confidence: 99%

“…Thus, in this population, thrombosis was not a frequent complication of IVIg therapy. 74 IVIg are sometimes used in SLE and in antiphospholipid syndrome (APS) treatment. APS is a condition in which the presence of antiphospholipid antibodies is related to development of arterial and venous thromboses, and it may affect subjects with or without other autoimmune disease, particularly SLE.…”

Section: Intravenous Immunoglobulinsmentioning

confidence: 99%

Thrombosis in Autoimmune Diseases: A Role for Immunosuppressive Treatments?

Silvestri

Scalera

Emmi

et al. 2016

Semin Thromb Hemost

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Autoimmune diseases are not infrequently associated with arterial or venous thrombotic events. Chronic inflammation and immune system impairment are considered the main pathogenetic mechanisms. Some of the drugs used in the treatment of such diseases have been associated with an increased risk of thrombosis. On the contrary, their anti-inflammatory and immune modulator activity could correct some mechanisms leading to thrombosis. In this review, recent evidence available on this topic is examined. There is a lack of adequate studies, but available evidence suggests that glucocorticoids and high-dose immunoglobulins are associated with an increased incidence of venous thromboembolism. Although available data do not allow drawing definite conclusions and more data are needed from future studies and registries, physicians should be aware of these associations.

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Intravenous immunoglobulin–associated thrombosis: is it such a rare event? Report of a pediatric case and of the Quebec Hemovigilance System

Abstract: Thrombosis after IVIG is a rare though SAE occurring mostly in adults. This underlines the importance of properly reporting IVIG SAEs to improve hemovigilance data and study such rare events.

Cited by 21 publications

References 17 publications

Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study

Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study

Effectiveness of immunoglobulin prophylaxis in reducing clinical complications of hematopoietic stem cell transplantation: a systematic review and meta‐analysis

Thrombosis in Autoimmune Diseases: A Role for Immunosuppressive Treatments?

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