tetano
Editor, Senior Moderator
Res Pract Thromb Haemost
. 2020 Jun 21;4(5):936-941.
doi: 10.1002/rth2.12390. eCollection 2020 Jul.
Heparin-induced thrombocytopenia with thrombosis in COVID-19 adult respiratory distress syndrome
Richard R Riker[SUP] 1 [/SUP], Teresa L May[SUP] 1 [/SUP], Gilles L Fraser[SUP] 1 [/SUP], David J Gagnon[SUP] 1 [/SUP], Mahesh Bandara[SUP] 2 [/SUP], Wesley R Zemrak[SUP] 1 [/SUP], David B Seder[SUP] 1 [/SUP]
Affiliations
Abstract
Early reports of coronavirus disease 2019 (COVID-19) clinical features describe a hypercoagulable state, and recent guidelines recommend prophylactic anticoagulation for patients with COVID-19 with low-molecular-weight heparin, but this would be contraindicated in the presence of heparin-induced thrombocytopenia (HIT). We address the key clinical question whether HIT is also present during COVID-19. We report 3 cases of thrombocytopenia with antiplatelet factor 4 antibodies among 16 intubated patients with COVID-19 with adult respiratory distress syndrome, a higher-than-expected incidence of 19%. Each patient had evidence of thrombosis (pulmonary embolism, upper extremity venous thromboses, and skin necrosis, respectively). The serotonin release assay confirmed HIT in 1 case, and 2 cases were negative. We believe this is the first reported case of HIT during the COVID-19 pandemic. Recognition that the thrombocytopenia represented HIT in the confirmed case was delayed. We recommend clinicians monitor platelet counts closely during heparin therapy, with a low threshold to evaluate for HIT.
Keywords: adult; coronavirus; heparin/ adverse effects; respiratory distress syndrome; thrombocytopenia/chemically induced; thrombosis.
. 2020 Jun 21;4(5):936-941.
doi: 10.1002/rth2.12390. eCollection 2020 Jul.
Heparin-induced thrombocytopenia with thrombosis in COVID-19 adult respiratory distress syndrome
Richard R Riker[SUP] 1 [/SUP], Teresa L May[SUP] 1 [/SUP], Gilles L Fraser[SUP] 1 [/SUP], David J Gagnon[SUP] 1 [/SUP], Mahesh Bandara[SUP] 2 [/SUP], Wesley R Zemrak[SUP] 1 [/SUP], David B Seder[SUP] 1 [/SUP]
Affiliations
- PMID: 32685905
- PMCID: PMC7276726
- DOI: 10.1002/rth2.12390
Abstract
Early reports of coronavirus disease 2019 (COVID-19) clinical features describe a hypercoagulable state, and recent guidelines recommend prophylactic anticoagulation for patients with COVID-19 with low-molecular-weight heparin, but this would be contraindicated in the presence of heparin-induced thrombocytopenia (HIT). We address the key clinical question whether HIT is also present during COVID-19. We report 3 cases of thrombocytopenia with antiplatelet factor 4 antibodies among 16 intubated patients with COVID-19 with adult respiratory distress syndrome, a higher-than-expected incidence of 19%. Each patient had evidence of thrombosis (pulmonary embolism, upper extremity venous thromboses, and skin necrosis, respectively). The serotonin release assay confirmed HIT in 1 case, and 2 cases were negative. We believe this is the first reported case of HIT during the COVID-19 pandemic. Recognition that the thrombocytopenia represented HIT in the confirmed case was delayed. We recommend clinicians monitor platelet counts closely during heparin therapy, with a low threshold to evaluate for HIT.
Keywords: adult; coronavirus; heparin/ adverse effects; respiratory distress syndrome; thrombocytopenia/chemically induced; thrombosis.