Risk of thrombotic events after inpatient intravenous immunoglobulin or plasma exchange for neurologic disease: A case-crossover study

Muscle Nerve. 2020 Sep;62(3):327-332. doi: 10.1002/mus.26884. Epub 2020 Apr 18.


Introduction: Our aim in this study was to determine whether intravenous immunoglobulin (IVIg) or plasma exchange (PLEx) for treatment of neurologic disease is a trigger for thrombotic events.

Methods: Using administrative data from 2005 to 2014, we identified index admissions for thrombotic events. We performed case-crossover analyses for these admissions with previous admissions for neurologic disease with IVIg or PLEx using exposure periods of between 7 and 120 days.

Results: We identified 1.9 million admissions for venous thrombosis embolism, myocardial infarction, or acute ischemic stroke. The odds ratio for venous thrombosis embolism within a 30-day window after exposure to IVIg was 3.33 (1.34-8.30, P = .0097) and for PLEx was 4.29 (1.88-9.76, P = .0005). Myocardial infarction and acute ischemic stroke admissions were not associated with exposure to either therapy.

Discussion: Patients admitted for venous thrombosis embolism (but not acute ischemic stroke or myocardial infarction) were more likely exposed to either IVIg or PLEx during previous admission for neurologic disease.

Keywords: IVIg; PLEx; adverse events; therapeutics; thrombosis; trigger.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / etiology*
  • Cross-Over Studies
  • Databases, Factual
  • Dermatomyositis / therapy
  • Female
  • Guillain-Barre Syndrome / therapy
  • Humans
  • Immunoglobulins, Intravenous / adverse effects*
  • Male
  • Middle Aged
  • Multiple Sclerosis / therapy
  • Myasthenia Gravis / therapy
  • Myocardial Infarction / etiology*
  • Plasma Exchange / adverse effects*
  • Polymyositis / therapy
  • Risk Factors
  • Stroke / etiology*
  • Venous Thromboembolism / etiology*


  • Immunoglobulins, Intravenous