Risk factors for stroke during intravenous immunoglobulin therapy:
(1) elderly patient with history of significant cerebrovascular and/or cardiac disease
(2) presence of risk factors associated with vascular disease (diabetes, hypertension, cigarette smoking, other)
(3) patients with hyperviscosity
(4) immune globulin product with high osmolality (> 350 mOsm per kg water)
where:
• I am not sure if atrial fibrillation would represent an additional risk.
Management:
(1) Consider an alternative therapy if significant risk factors are present.
(2) Use an immune globulin product with a low osmolality.
(3) Administer antiplatelet agents prior to and during therapy.
