Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: A two-year study

Abstract

The incidence and determinants of thromboembolic complications (TEC) of intravenous immunoglobulin (IVIg) therapy in patients with dysimmune neuropathy are uncertain. We performed a retrospective study of patients with dysimmune neuropathy seen at our institution and treated with IVIg, over a 24-month period. Sixty-two patients were treated with a total of 616 courses of IVIg. TEC occurred in 7 patients. In 5, these occurred within 14 days after IVIg infusion ("early TEC"). Early TEC were significantly more frequent after courses administered to IVIg-naïve patients (3/25 vs. 2/591 courses; p<0.001), but incidences were comparable in newly- vs. previously-treated patients (3/25 vs. 2/44 patients; p=0.34). Early TEC included 2 cases of myocardial infarction, one of acute coronary syndrome, one of deep vein thrombosis (DVT) with pulmonary embolism and one of isolated DVT. Mean dose per course was comparable in affected and unaffected patients (p=0.47), but administration of daily doses ≥ 35 g correlated significantly with occurrence of early TEC (p=0.028). Previous coronary disease (p=0.037) and immobility at time of treatment (p=0.049) were independent predictors of early TEC. Patients with early TEC had significantly more risk factors (p<0.001), and were significantly more likely to have ≥ 4 risk factors (p=0.006), than those without early TEC. The risk of TEC with IVIg is not negligible in patients with neuropathy. Although higher with a first-ever infusion, the general risk may be comparable in IVIg-naïve and previously-treated patients. Administration of daily doses ≥ 35 g of IVIg may carry a greater risk of early TEC. Coronary disease, immobility at time of treatment, presence of ≥ 4 risk factors, should lead to caution and consideration of alternative treatments.