What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?

I am unaware of any published data to guide the decision-making for this topic. Empirically, I recommend low-dose aspirin in patients >50 who have to get long-term IVIG especially if there are a lot of underlying risk factors for thrombosis like diabetes, immobility, etc. Again, this is not an evidence-based recommendation. It is also important for patients to maintain good hydration on the days of IVIG infusion. An even more controversial question is what to do if a patient has a thrombotic event while on IVIG. I had discussed this in a panel of neuromuscular experts a few years ago, and a few colleagues suggested continuing IVIG as long as the patient continued to receive anticoagulation such as warfarin or DOAC, and the thrombotic event ...

There's not much available literature on this, but the risk is probably related to peak dosing. I couldn’t find a report of thrombosis with SCIg, but the warning is there and the risk must be very low. So, I would use SCIg when I can. Otherwise, my approach is to spread the treatment out; lower doses per infusion spread it out, skip a day, and use low-dose weekly IVIg for maintenance (venous access may become an issue). There’s nothing that forces us to complete the induction dose in 5 days.