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

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 includedheparin-induced thrombocytopenia,HIT,intravenous immune globulin,IVIG,autoimmune HIT,aHIT, andimmune 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 x 10(9)/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.

Automated summary

The effectiveness of IVIG in treating aHIT patients was evaluated, showing good results in increasing platelet count and a favorable platelet recovery within 5 days after IVIG administration.