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Title: | Slow and steady. Reducing thrombotic events in renal transplant recipients treated with IVIg for antibody-mediated rejection. | Authors: | Mulley W. ;Kanellis J.;Huang L. | Institution: | (Huang, Kanellis, Mulley) Department of Nephrology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia (Kanellis, Mulley) Department of Medicine, Monash University, Clayton, VIC, Australia | Issue Date: | 5-Oct-2012 | Copyright year: | 2011 | Publisher: | Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053, Australia) | Place of publication: | Australia | Publication information: | Nephrology. 16 (2) (pp 239-242), 2011. Date of Publication: February 2011. | Abstract: | Intravenous immunoglobulin (IVIg) therapy for antibody-mediated rejection (AMR) is increasing and is associated with a small but significant incidence of thrombosis. We determined thrombosis rates in patients treated with high-dose IVIg for AMR before and after alteration of an infusion protocol. The newer protocol introduced routine administration of aspirin 300 mg, enoxaparin 1 mg/kg, intravenous hydration and a maximum infusion rate of 100 mg/kg per hour (previously 200 mg/kg per hour). Nine thromboses in 275 infusions occurred before the protocol alteration (event rate 3.3%). Two were arterial thromboses including an acute myocardial infarct and a renal transplant artery thrombosis, which resulted in infarction of 2/3 of the graft. Seven venous thromboses occurred, six in arteriovenous fistulae and one case with bilateral above knee deep venous thromboses. Significant associations with thromboses were seen with higher IVIg dose and male sex. In the 6 months since the introduction of the new infusion protocol, 74 infusions have been administered with no thrombotic events. There have been no significant bleeding or fluid overload side-effects. Infusion times, however, have been doubled. A slower rate of infusion combined with antiplatelet and anticoagulation has thus far eliminated the small but significant IVIg-related thrombosis rate previously observed in our patients treated for AMR without resulting in significant side-effects. Further study is now required to define which elements of this protocol are essential. © 2011 Asian Pacific Society of Nephrology. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/j.1440-1797.2010.01399.x | PubMed URL: | 21272138 [http://www.ncbi.nlm.nih.gov/pubmed/?term=21272138] | ISSN: | 1320-5358 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/30263 | Type: | Article | Subjects: | adult antibody mediated rejection/dt [Drug Therapy] anticoagulant therapy arteriovenous fistula/pc [Prevention] article bleeding/si [Side Effect] deep vein thrombosis/dt [Drug Therapy] deep vein thrombosis/pc [Prevention] deep vein thrombosis/si [Side Effect] Doppler echography drug dose increase drug infusion drug megadose female fluid overload/si [Side Effect] graft recipient heart infarction/pc [Prevention] human hydration *kidney graft rejection/co [Complication] *kidney graft rejection/dt [Drug Therapy] *kidney graft rejection/pc [Prevention] kidney graft rejection/dt [Drug Therapy] *kidney transplantation leg thrombosis/dt [Drug Therapy] leg thrombosis/pc [Prevention] leg thrombosis/si [Side Effect] major clinical study male medical record review non ST segment elevation myocardial infarction/dt [Drug Therapy] non ST segment elevation myocardial infarction/pc [Prevention] non ST segment elevation myocardial infarction/si [Side Effect] priority journal renal artery thrombosis/dt [Drug Therapy] renal artery thrombosis/pc [Prevention] renal artery thrombosis/si [Side Effect] enoxaparin/sc [Subcutaneous Drug Administration] *immunoglobulin G/ae [Adverse Drug Reaction] *immunoglobulin G/do [Drug Dose] *immunoglobulin G/dt [Drug Therapy] *immunoglobulin G/iv [Intravenous Drug Administration] infusion fluid prednisolone/dt [Drug Therapy] warfarin/ae [Adverse Drug Reaction] warfarin/dt [Drug Therapy] *antibody mediated rejection/co [Complication] *antibody mediated rejection/dt [Drug Therapy] *antibody mediated rejection/pc [Prevention] clinical protocol retrospective study sex difference side effect/si [Side Effect] *thrombosis prevention treatment duration vein thrombosis/dt [Drug Therapy] vein thrombosis/pc [Prevention] vein thrombosis/si [Side Effect] acetylsalicylic acid/ae [Adverse Drug Reaction] acetylsalicylic acid/dt [Drug Therapy] acetylsalicylic acid/iv [Intravenous Drug Administration] clopidogrel/ae [Adverse Drug Reaction] clopidogrel/dt [Drug Therapy] enoxaparin/ae [Adverse Drug Reaction] enoxaparin/dt [Drug Therapy] graft recipient heart infarction / prevention human hydration *kidney graft rejection / *complication / *drug therapy / *prevention kidney graft rejection / drug therapy *kidney transplantation leg thrombosis / drug therapy / prevention / side effect major clinical study male medical record review non ST segment elevation myocardial infarction / drug therapy / prevention / side effect priority journal renal artery thrombosis / drug therapy / prevention / side effect retrospective study sex difference side effect / side effect *thrombosis prevention treatment duration vein thrombosis / drug therapy / prevention / side effect article arteriovenous fistula / prevention anticoagulant therapy antibody mediated rejection / drug therapy bleeding / side effect adult clinical protocol deep vein thrombosis / drug therapy / prevention / side effect Doppler echography drug dose increase drug infusion drug megadose female fluid overload / side effect |
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