Heparin-induced thrombocytopenia with thrombosis in COVID-19 adult respiratory distress syndrome.

Research and Practice in Thrombosis and Haemostasis
Richard R RikerDavid B Seder

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.

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Citations

Sep 15, 2020·Journal of Cardiovascular Pharmacology and Therapeutics·Antonis S ManolisHelen Melita
Aug 25, 2020·Research and Practice in Thrombosis and Haemostasis·Jori E MayMarisa Marques
Sep 10, 2020·Thrombosis Journal·Michael TranDeborah Hornacek
Jul 29, 2020·Critical Care : the Official Journal of the Critical Care Forum·Shu-Chen LiaoMing-Jui Hung
Aug 25, 2020·Research and Practice in Thrombosis and Haemostasis·Richard R RikerDavid B Seder
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Feb 8, 2021·Journal of Thrombosis and Haemostasis : JTH·Justine BrodardAndreas Greinacher
Apr 16, 2021·Circulation Research·Mina K ChungJoseph Loscalzo
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Methods Mentioned

BETA
blood draws

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