ArticleFrontiers in pharmacology2026
Evaluating the association between intravenous immunoglobulin and thromboembolic events in patients with autoimmune diseases: a retrospective real-world study.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intravenous immunoglobulin (IVIG), a cornerstone in the management of autoimmune diseases (ADs), entails a concerning risk of thromboembolic events (TEEs). Current risk-stratification models, however, suffer from a critical omission, as they do not include dynamic biomarkers such as D-dimer. Additionally, the effectiveness of intermittent pneumatic compression (IPC) as a physical thromboprophylactic measure before IVIG infusion constitutes an unmet research need. This study was therefore designed to fill these voids by defining the incidence and independent risk factors for IVIG-associated thrombosis in AD patients and by evaluating the prophylactic potential of IPC, with the ultimate goal of informing risk identification and prevention strategies for high-risk patients. Methods: This study enrolled all AD patients receiving IVIG between January 2022 and October 2024. Patients were grouped by TEE occurrence. We analyzed demographic, clinical, and laboratory data to calculate TEE incidence, identify independent risk factors via logistic regression, and assess the cumulative IVIG dose-TEE association using Kaplan-Meier curves. Results: The incidence of thromboembolic events was 9.36% (57/609). Multivariate analysis identified these independent risk factors for TEEs: cumulative IVIG dose (OR = 1.00, 95% CI: 1.00-1.00, P = 0.018), age ≥60 (OR = 2.91, 95% CI: 1.52-5.80, P = 0.002), immobility ≥3 days (OR = 6.28, 95%CI: 2.44-20.54, P = 0.001), diagnosis of myelitis (OR = 3.40, 95% CI: 1.01-10.64, P = 0.040) or acute post-transplant rejection (OR = 2.98, 95% CI: 1.02-8.64, P = 0.044), elevated pre-treatment D-dimer (OR = 4.56, 95% CI: 2.14-10.63, P < 0.001), and glucocorticoid use (OR = 2.04, 95% CI: 1.04-4.13, P = 0.041). Pre-treatment IPC showed no protective effect (P = 0.107). A significant dose-response relationship existed, with TEEs increasing markedly above cumulative doses of 100 g. Conclusion: Independent risk factors for IVIG-associated thrombosis in AD patients included age ≥60, myelitis, transplant rejection, immobility ≥3 days, IVIG dose >100 g, elevated pre-treatment D-dimer, and glucocorticoid use. Prophylactic low-molecular-weight heparin is recommended for these high-risk individuals.
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