Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19

Julian, Katherine; Bucher, Donald; Jain, Rohit

doi:10.1136/bcr-2021-243315

Cited by 8 publications

(4 citation statements)

References 16 publications

(20 reference statements)

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“…Furthermore, it is important to acknowledge that administering heparin to hospitalized COVID-19 patients as a preventive measure against blood clotting may increase the risk of heparin-induced thrombocytopenia, a potentially life-threatening complication. This complication could potentially interact with the thrombocytopenia syndrome caused by the COVID-19 vaccine 25 .…”

Section: Discussionmentioning

confidence: 99%

Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials

Amin,

Qayyum,

Uzair

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: Hospitalized patients with COVID-19 have shown a significant occurrence of thromboembolism and a heightened risk of death. It remains unclear whether factor Xa inhibitors are superior to enoxaparin in this context. Hence, there is a need for a direct comparison to assess the preventive effects and safety of factor Xa inhibitors versus enoxaparin in hospitalized COVID-19 patients. Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) or retrospective studies that compared the effectiveness or safety of factor Xa inhibitors and enoxaparin in preventing thromboembolism in hospitalized patients with COVID-19. Embolic incidence, incidence of bleeding, and all-cause mortality were among the outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 percent confidence intervals (CIs). Results: The analysis included 6 RCTs and 2 retrospective studies containing 4048 patients. Meta-analysis showed a statistically significant reduction among patients on factor Xa inhibitors compared with LMWH in the embolic incidence (RR 0.64 [95%, CI 0.42, 0.98]; P=0.04, I2=12%). Upon subgroup analysis by type of study design, no significant reductions were noted in patients on factor Xa inhibitors in RCTs (RR: 0.62; 95% CI: 0.33–1.17; P=0.14) or observational studies (RR: 0.53; 95% CI: 0.23–1.26; P=0.15) when compared with enoxaparin Factor Xa inhibitors were not significantly associated with incidence of bleeding (RR 0.76 [95% CI 0.36, 1.61]; P=0.47, I2=0%) or all-cause mortality (RR: 0.81; 95% CI: 0.48–1.36; P=0.43). Consistent results were obtained upon subgroup analysis by the type of study design. Conclusion: Factor Xa inhibitors are more effective than enoxaparin in preventing thromboembolism among patients with COVID-19 who are not acutely ill and are hospitalized. Additional rigorous randomized controlled trials (RCTs) comparing factor Xa inhibitors with enoxaparin are warranted.

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Section: Discussionmentioning

confidence: 99%

Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials

Amin,

Qayyum,

Uzair

et al. 2024

Annals of Medicine &Amp; Surgery

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“…aHIT includes HIT associated with infections, and a small number of cases of aHIT caused by viral infections have been reported [ 13 , 14 ]. In fact, a case report [ 15 ] of a patient with COVID-19 who was positive for HIT antibodies and who developed thrombosis despite not using heparin has been published, although it is unclear at present if SARS-CoV-2 infection itself predisposes a person to HIT. It cannot be determined if aHIT was involved in our case because the thrombosis of our patient occurred after heparin administration.…”

Section: Discussionmentioning

confidence: 99%

A case of severe COVID-19 with pulmonary thromboembolism related to heparin-induced thrombocytopenia during prophylactic anticoagulation therapy

Sasaki¹,

Murata²,

Nakamura³

et al. 2022

Journal of Infection and Chemotherapy

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“…In fact, several cases of spontaneous HIT have been associated with COVID-19. [ 14 , 15 ] In addition, cases of other COVID-associated immunohematologic phenomenon, including immune thrombocytopenic purpura and autoimmune hemolytic anemia, have been well-documented. [ 16 , 17 ] The regional, national, and global number of cases at the time of presentation with the paucity of reported spontaneous HIT cases highlight the rarity of this acquired thrombogenic complication of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Limb ischemia due to spontaneous heparin-induced thrombocytopenia as the primary presentation of acute COVID-19 infection

Shiuan

Sharma

Ely

et al. 2022

J Thromb Thrombolysis

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Heparin-induced thrombocytopenia (HIT) occurs with the development of IgG antibodies that bind complexes of heparin and platelet factor 4 (PF4), which activate platelets and result in a profoundly prothrombotic condition. In rare instances, this syndrome develops in the absence of proximate heparin administration, referred to as spontaneous HIT, for which less than three dozen cases have been reported. Spontaneous HIT is considered a subtype of “autoimmune HIT” (aHIT), characterized by platelet activation in the serotonin release assay (SRA) without the addition of exogenous heparin. Here, we report spontaneous HIT as the presenting feature in a patient with 2019 coronavirus disease infection (COVID-19). A 66-year-old male presented with progressive leg pain and was found to have a platelet count of 39 × 10 9 /L and multiple lower extremity arterial thromboses requiring fasciotomy and thrombectomy. He had no recent hospitalization, heparin exposure, vaccinations, or known thrombophilia. He had a strongly positive IgG-specific enzyme-linked immunosorbent assay for heparin-PF4 antibodies, and the SRA was strongly positive both with and without the addition of heparin. He was treated successfully with bivalirudin, intravenous immunoglobulin, and apixaban.

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Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19

Cited by 8 publications

References 16 publications

Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials

Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials

A case of severe COVID-19 with pulmonary thromboembolism related to heparin-induced thrombocytopenia during prophylactic anticoagulation therapy

Limb ischemia due to spontaneous heparin-induced thrombocytopenia as the primary presentation of acute COVID-19 infection

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