A patient receiving intravenous immunoglobulin may rarely suffer a cerebral infarction. Patients with risk factors should be identified and receive either an alternative therapy or prophylactic drug therapy.


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)



• I am not sure if atrial fibrillation would represent an additional risk.



(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.


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