In acute coronary syndromes, GPIIb/IIIa platelet inhibitors have demonstrated a reduction in recurrent myocardial ischemia. Conversely, one might expect that enhancing platelet activity in patients in acute coronary syndromes would have the opposite effect. We report a patient with idiopathic thrombocytopenic purpura (ITP) that had recurrent myocardial ischemia asso ciated with administration of intravenous immunogloblin (IVIG). Literature is reviewed.
Get full access to this article
View all access options for this article.
References
1.
Woodruff RK, Grigg AP, Firkin FC, et al: Fatal thrombotic events during treatment of autoimmune thrombocytopenia with intravenous immunoglobulin in elderly patients. Lancet2:217-218, 1986.
2.
Ronda N., Hurez V., Kazatchkine MD: Intravenous immunoglobulin therapy of autoimmune and systemic inflammatory diseases. Vox Sang64:65-72, 1993.
3.
Reinhart WH, Berchtold PE: Effect of high-dose intravenous immunoglobulin therapy on blood rheology . Lancet339:662-664, 1992.
4.
Schulman SP, Goldschmidt-Clermont PJ, Topol EJ, et al: Effects of Integrelin, a platelet glycoprotein IIb/IIIa receptor antagonist, in unstable angina. A randomized multicenter trial. Circulation94:2083-2089, 1996.
5.
CAPTURE Investigators: Randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: The CAPTURE Study. Lancet349:1429-1435, 1997.
6.
Dalakas MC: High-dose intravenous immunoglobulin and serum viscosity: Risk of precipitating thromboembolic events. Neurology44:223-226, 1994.
7.
Fisman DN, Smilovitch M.: Intravenous immunoglobulin, blood viscosity and myocardial infarction . Can J Cardiol13:775-777, 1997.
8.
Gordon RJ, Snyder GK, Tritel H., et al: Potential significance of plasma viscosity and hematocrit variations in myocardial ischemia. Am Heart J87 :175-182, 1974.
9.
Koenig W., Ernst E.: The possible role of hemorheology in atherothrombogenesis. Atherosclerosis94 :93-107, 1992.
10.
Rainer C., Kawanishi DT, Chandraratna PA, et al: Changes in blood rheology in patients with stable angina pectoris as a result of coronary artery disease. Circulation76:15-20, 1987.
11.
Yarnell JW, Baker IA, Sweetnam PM, et al: Fibrinogen, viscosity, and white blood count are the major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies. Circulation83:836-844, 1991.
12.
NIH Consensus Conference: Intravenous immunoglobulin. Prevention and treatment of disease. JAMA 264:3189-3193, 1990.
13.
Ratko TA, Burnett DA, Foulke GE, et al: Recommendations for off-label use of intravenously administered immunoglobulin preparations. JAMA273: 1865-1870, 1995.
14.
Rosenbaum JT : Myocardial infarction as a complication of immunoglobulin therapy. Arthritis Rheum40:1732-1733, 1997.
15.
Haplea SS, Farrar JT, Gibson GA, et al: Thromboembolic events associated with intravenous immunoglobulin therapy. Neurology48:A54, 1997.
16.
Elkayam O., Paran D., Milo R., et al: Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autoimmune disorders. A study of four cases. Ann Rheum Dis59:77-80, 2000.
