Early high-dose intravenous immunoglobulin for refractory heparin-induced thrombocytopenia with stroke: Two case reports

J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107032. doi: 10.1016/j.jstrokecerebrovasdis.2023.107032. Epub 2023 Jan 24.

Abstract

Background: High-dose intravenous immunoglobulin (IVIg) can be effective for patients with refractory autoimmune heparin-induced thrombocytopenia (HIT). We report two patients with autoimmune HIT (aHIT) successfully treated with early high-dose IVIg.

Case description: Case 1 was a 48-year-old male who had persisting HIT with recurrent ischemic stroke after mitral valve replacement. Case 2 was a 71-year-old male who had flush heparin HIT with cerebral venous thrombosis after total hip arthroplasty. High-dose IVIg was administered 6 and 4 days after starting argatroban due to non-improved thrombocytopenia and persistently high D-dimer values, respectively. Both patients achieved favorable functional recovery at discharge as well as improvements of thrombocytopenia and hypercoagulation.

Conclusions: Early high-dose IVIg may be effective for patients with aHIT and hypercoagulability.

Keywords: Autoimmune HIT; Flush heparin HIT; Heparin-induced thrombocytopenia (HIT); Intravenous immunoglobulin (IVIg); Persisting HIT; Stroke.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants
  • Heparin / therapeutic use
  • Humans
  • Immunoglobulins, Intravenous
  • Male
  • Middle Aged
  • Pipecolic Acids / therapeutic use
  • Stroke* / diagnosis
  • Stroke* / drug therapy
  • Thrombocytopenia* / chemically induced
  • Thrombocytopenia* / diagnosis
  • Thrombocytopenia* / drug therapy

Substances

  • Immunoglobulins, Intravenous
  • Heparin
  • Anticoagulants
  • Pipecolic Acids