Abstract Details

Title Risk of Thrombotic Events after Exposure to Intravenous Immunoglobulin or Plasma Exchange for Treatment of Neurologic Disease

Topic General Neurology

Presentation(s) S27 - General Neurology: Improving Neurologic Care and the Impact of Therapeutics (1:11 PM-1:22 PM)

Poster/Presentation
Number 002

Background Various neurologic diseases are treated with IVIG or PLEX. In practice, IVIG is avoided in patients at risk for thrombotic events. Data supporting this practice is limited. We hypothesized that treatment with IVIG would be associated with greater risk for subsequent thrombotic events compared to PLEX.

Objective To determine if use of intravenous immunoglobulin (IVIG) or plasma exchange (PLEX) for neurologic disease is associated with risk for thrombotic events.

Design/Methods Using the State Inpatient Databases and Emergency Department Databases for New York, Florida, and California (2005-2014), we identified index admissions for acute ischemic stroke (AIS), venous thrombotic embolism (VTE), and myocardial infarction (MI) using validated ICD-9CM codes. To assess whether exposure to IVIG and PLEX during admission for neurologic disease (myasthenia gravis, Gullain-Barré Syndrome, chronic inflammatory demyelinating polyneuropathy, dermatomyositis, polymyositis, or multiple sclerosis) was associated with subsequent thrombotic events, we performed a case-crossover analysis for each intervention and each thrombotic event in separate conditional logistic regression models (estimating odds ratios [OR] and 95% confidence intervals [CI]), with each individual serving as their own control.

Results

We identified 495745 index admissions for VTE, 807117 for MI, and 626140 for AIS. There was an increased risk of VTE within a 30-day window after exposure to IVIG (OR 3.33, 95% CI 1.34-8.30, p=0.0097) and PLEX (OR 4.29, 95% CI 1.88-9.76, p=0.0005). Within a 120-day window, the increased risk for VTE was greater with IVIG (OR 4.54, 95% CI 2.49-8.27, p<0.0001) and PLEX (OR 5.93, 95% CI 3.43-10.25, p<0.0001). There was no significant associated risk for AIS or MI with either PLEX or IVIG exposure after 120 days, but the sample sizes were small.

Conclusions Treatment of neurologic disease with both IVIG and PLEX was associated with increased risk for VTE. Our results do not support the clinical practice of avoiding IVIG to decrease risk for thrombotic events.

Authors/Disclosures
Peter Jin, MD (University of Maryland School of Medicine) PRESENTER	Dr. Jin has nothing to disclose.
Laura Stein, MD (Mount Sinai School of Medicine)	The institution of Dr. Stein has received research support from American Heart Association.
Susan Shin, MD (Mount Sinai Hospital)	Dr. Shin has nothing to disclose.
Mandip S. Dhamoon, MD, MPH	Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Faegre Baker Daniels LLP. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wellstar Health System Inc. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Fabiani Cohen & Hall, LLP. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Kramer, Dillof, Livingston & Moore. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Robins Kaplan. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Parker Waichman LLP. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Heidell, Pittoni, Murphy & Bach, LLP.

��ɫ��

��ɫ��