Evaluation of the risk factors predicting thrombotic complications associated with intravenous immunoglobulin therapy in neuroimmunological diseases.
Intravenous immunoglobulin
Modified Rankin Scale
Neuroimmunological disease
Risk factors
Thrombotic complications
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
14
10
2020
accepted:
16
03
2021
pubmed:
23
4
2021
medline:
15
12
2021
entrez:
22
4
2021
Statut:
ppublish
Résumé
Intravenous immunoglobulin (IVIg) therapy is increasingly used for various conditions that include neuroimmunological disorders, such as chronic inflammatory demyelinating polyneuropathy, Guillain-Barré syndrome, myasthenia gravis, and myositis. Although IVIg therapy is considered a relatively safe treatment, previous studies have reported thrombotic complications associated with IVIg (TCI). The precise mechanisms and associated risk factors have not been fully elucidated to date. Three of our patients experienced TCI. Although immobility is one of the most common risk factors for venous thrombosis, all three patients could walk without assistance; their modified Rankin Scale (mRS) scores were 2. We assessed the clinical characteristics of these patients and compared their data with that of 65 patients who received IVIg from the years 2000 to 2019 without experiencing TCI to identify associated risk factors. The frequency of TCI among patients with neuroimmunological disorders at our hospital was 4.4% (3/68 patients). There were no significant differences between the patients with and without TCI regarding their mean age (69.7 vs 58.0 years, p = 0.244), percentage of females (66.7% vs 45.6%, p = 0.588), mean body mass index (22.67 vs 22.16, p = 0.878), mean mRS score (2.22 vs 2.00, p = 0.658), and use of oral prednisolone (66.7% vs 13.8%, p = 0.0658). Interestingly, the D-dimer levels of two of the patients with TCI were not elevated before treatment. Sixteen patients received anticoagulant therapy during IVIg treatment, and none suffered from TCI. As our analysis suggested, it might be important to monitor D-dimer levels before and after IVIg to help prevent and detect TCI.
Identifiants
pubmed: 33884526
doi: 10.1007/s10072-021-05192-4
pii: 10.1007/s10072-021-05192-4
doi:
Substances chimiques
Immunoglobulins, Intravenous
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5321-5326Informations de copyright
© 2021. Fondazione Società Italiana di Neurologia.
Références
Lin J, Xue B, Zhu R, Pan J, Li J, Lin Y, Li X, Xia J (2021) Intravenous immunoglobulin as the rescue treatment in NMOSD patients. Neurol Sci
Marie I, Maurey G, Hervé F, Hellot MF, Levesque H (2006) Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature. Br J Dermatol 155:714–721
doi: 10.1111/j.1365-2133.2006.07390.x
Eftimov F, Winer JB, Vermeulen M, de Haan R, van Schaik IN (2013) Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 12
Hughes RA, Swan AV, van Doorn PA(2014) Intravenous immunoglobulin for Guillain-Barrésyndrome. Cochrane Database Syst Rev (9)
Meriggioli MN (2007) IVIG in myasthenia gravis: getting enough “bang for the buck”. Neurology. 68(23):803–804
doi: 10.1212/01.wnl.0000259335.05741.5f
Dalakas MC, Illa I, Dambrosia JM, Soueidan SA, Stein DP, Otero C, Dinsmore ST, McCrosky S (1993) A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 329(27):1993–2000
doi: 10.1056/NEJM199312303292704
Rajabally YA, Kearney DA (2011) Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: a two-year study. J Neurol Sci 308(1–2):124–127
doi: 10.1016/j.jns.2011.05.035
Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458
doi: 10.1038/bmt.2012.244
Cohan A, Spiro T (2014) D-dimer as a predictor of venous thromboembolism in acutely ill, hospitalized patients: A subanalysis of the randomized controlled MAGELLAN trial. J Thromb Haemost 12(4):479–487
doi: 10.1111/jth.12515
Marik PE, Plante LA (2008) Venous thromboembolic disease and pregnancy. N Engl J Med 359(19):2025–2033
doi: 10.1056/NEJMra0707993
van Vlijmen EF, Brouwer JL, Veeger NJ (2007) Oral contraceptives and the absolute risk of venous thromboembolism in women with single or multiple thrombophilic defects: results from a retrospective family cohort study. Arch Intern Med 167(3):282–289
doi: 10.1001/archinte.167.3.282
Roach REJ, Cannegieter SC, Lijfering WM (2014) Differential risks in men and women for first and recurrent venous thrombosis: the role of genes and environment. J Thromb Haemost 12(10):1593–1600
doi: 10.1111/jth.12678
van Zaane B, Nur E (2010) Systematic review on the effect of glucocorticoid use on procoagulant, anti-coagulant and fibrinolytic factors. J Thromb Haemost 8(11):2483–2493
doi: 10.1111/j.1538-7836.2010.04034.x
Johannesdottir SA, Horváth-Puhó E, Dekkers OM (2013) Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study. JAMA Intern Med 173(9):743–752
doi: 10.1001/jamainternmed.2013.122
Brotman DJ, Girod JP, Posch A, Jani JT (2006) Effects of short-term glucocorticoids on hemostatic factors in healthy volunteers. Thromb Res 118(2):247–252
doi: 10.1016/j.thromres.2005.06.006
Feuillet L, Guedj E, Laskiri N (2014) Deep vein thrombosis after intravenous immunoglobulins associated with methylprednisolone. Thromb Haemost 92:662–665