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The optimal application of these therapies is unknown and outcomes data are limited. We investigated treatment categories and laboratory and clinical outcomes of IVIG and\/or TPE in HIT with a systematic literature review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>We searched MEDLINE, Embase, and Web of Science through December 2019 for studies combining controlled vocabulary and keywords related to thrombocytopenia, heparin, TPE, and IVIG. The primary outcome was treatment indication. Secondary outcomes were platelet recovery, HIT laboratory parameters, heparin re\u2010exposure, and post\u2010treatment course. Case\u2010level data were analyzed by qualitative synthesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 4241 references were screened, we identified 60 studies with four main categories of IVIG and\/or TPE use as follows: (a) treatment of refractory HIT (n = 35; 31%); (b) initial therapy (n = 45; 40%); (c) cardiopulmonary bypass surgery (CPB; n = 30; 27%); and (d) other (n = 2; 2%). IVIG was most commonly used for the treatment of refractory HIT while TPE was primarily used to facilitate heparin exposure during CPB. Both IVIG and TPE were equally used as initial therapy. Heparin re\u2010exposure occurred without thrombotic event in 29 TPE\u2010treated patients and three IVIG\u2010treated patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with HIT, both TPE and IVIG are used for initial therapy or treatment of refractory HIT. However, TPE is more commonly used in patients undergoing CPB. Prospective studies may help clarify which treatment is indicated in HIT population subsets.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.16018","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T05:42:45Z","timestamp":1598593365000},"page":"2714-2736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Therapeutic plasma exchange and intravenous immune globulin in the treatment of <scp>heparin\u2010induced<\/scp> thrombocytopenia: A systematic review"],"prefix":"10.1111","volume":"60","author":[{"given":"Chinonso","family":"Onuoha","sequence":"first","affiliation":[{"name":"Department of Pediatrics East Carolina University, Vidant Medical Center  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen D.","family":"Barton","sequence":"additional","affiliation":[{"name":"Medical Center Library Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward C.C.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Pathology George Washington School of Medicine and Health Sciences  Washington, DC USA"},{"name":"Department of Coagulation Quest Diagnostics, Nichols Institute  Centreville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay S.","family":"Raval","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian A.","family":"Rollins\u2010Raval","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina S.","family":"Ipe","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Medicine Vitalant Northeast Division and The University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard I.","family":"Boral","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Kentucky Health Care  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8862-4808","authenticated-orcid":false,"given":"Jill","family":"Adamksi","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic Arizona  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole D.","family":"Zantek","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7266-7101","authenticated-orcid":false,"given":"Oluwatoyosi A.","family":"Onwuemene","sequence":"additional","affiliation":[{"name":"Department of Medicine Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.2.370"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24759"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(18)30046-2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.05.080"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181c3c1cd"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2019.05.010"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-08-803031"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1801799"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-018-0699-4"},{"key":"e_1_2_9_12_1","unstructured":"Covidence. 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