REVIEW ARTICLEEffectiveness of intravenous immunoglobulin use in heparin-induced thrombocytopeniaAryal, Madan R.a; Gosain, Rohita; Donato, Anthonyb; Katel, Anjanc; Chakradhar, Rikeshd; Dhital, Rashmib; Kouides, Peter A.eAuthor Information aDepartment of Medicine, Roswell Park Comprehensive Cancer Centre, University at Buffalo, Buffalo, New York bDepartment of Medicine, Tower Health System, Reading, Pennsylvania, USA cDepartment of Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal dDepartment of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas eDepartment of Medicine, Rochester Regional Health, Rochester, New York, USA Correspondence to Anjan Katel, Department of Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal E-mail: firstname.lastname@example.org Received 23 January, 2020 Accepted 25 March, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.bloodcoagulation.com). Blood Coagulation & Fibrinolysis: July 2020 - Volume 31 - Issue 5 - p 287-292 doi: 10.1097/MBC.0000000000000918 Buy SDC Metrics Abstract Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and nonheparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin (IVIg) have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the published literature on use of IVIg in the treatment of HIT. A systematic search of PubMed, Google Scholar, EMBASE and SCOPUS for all study designs and reports were carried out from inception until April 2019. Statistical analysis was done using Microsoft Excel and Stata version 13. In 34 patients with HIT, the mean age was 60 years. About 70% cases were by unfractionated heparin exposure and 30% by low-molecular weight heparin. The most common precipitant in the patients without heparin exposure was recent surgery. Average nadir platelet count for which IVIg was used was 28 000/μl. Time from resolution of the thrombocytopenia after IVIg treatment was 3 days with average platelet count recovery to 159 000/μl. Mean time from diagnosis to administration of IVIg was day 18. Thrombosis was identified in 32% of patients. About 77% patients improved (platelet count >100 000/μl or cessation of thrombosis) following use of IVIg. Logistic regression did not identify any factors that predicted IVIg response (P > 0.05). No thrombotic events or other adverse events were noted with use of IVIg. IVIg appears to be a safe and effective treatment option for HIT-related thrombocytopenia and for refractory thrombosis. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.