Bleeding is associated with intravenous immunoglobulin and therapeutic plasma exchange use in heparin-induced thrombocytopenia: A propensity matched analysis

Alexandre Soares Ferreira Júnior; Stephen H Boyle; Maragatha Kuchibhatla; Oluwatoyosi A Onwuemene

doi:10.1002/jha2.211

Bleeding is associated with intravenous immunoglobulin and therapeutic plasma exchange use in heparin-induced thrombocytopenia: A propensity matched analysis

EJHaem. 2021 May 7;2(3):466-470. doi: 10.1002/jha2.211. eCollection 2021 Aug.

Authors

Alexandre Soares Ferreira Júnior^{1

2}, Stephen H Boyle³, Maragatha Kuchibhatla⁴, Oluwatoyosi A Onwuemene⁵

Affiliations

¹ School of Medicine Barretos School of Health Sciences Dr. Paulo Prata Barretos São Paulo Brazil.
² Department of Medicine Faculdade de Medicina de São José do Rio Preto (FAMERP) São José do Rio Preto São Paulo Brazil.
³ Duke University School of Medicine Durham North Carolina USA.
⁴ Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA.
⁵ Division of Hematology Department of Medicine Duke University School of Medicine Durham North Carolina USA.

Abstract

Intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE) are used in select cases with heparin-induced thrombocytopenia (HIT). In a cross-sectional analysis, a propensity matched sample was generated by IVIG or TPE treatment status to assess the primary outcome of mortality. In 500 HIT cases, IVIG or TPE was not associated with increased mortality (OR = 1.46; 95% CI: 0.81-2.63, p = 0.2052) but was associated with a higher likelihood of major bleeding (OR = 1.75; 95% CI: 1.03-2.96, p = 0.0376). The use of IVIG or TPE in HIT cases with bleeding contraindications to standard therapies should be further investigated.

Keywords: National Inpatient Sample; heparin‐induced thrombocytopenia; intravenous immune globulin; therapeutic plasma exchange.