COVID-19 and Thrombocytopenia: Heparin or Sepsis-Induced?

Abstract

Check for updates bleeding or bruising, pain, redness or skin modification in injection-side. Heparin induce-thrombocytopenia (HIT) without or with thrombosis (HITT) is a known, potentially fatal, side effect caused by antibodies against complexes containing platelet factor 4 (PF4) and heparin. Only 0.2% to 3% of heparin-exposed patients present thrombocytopenia and/or thrombosis [5]. Most important tool is differential diagnosis that could be difficult due to the overlap of HIT with other medical conditions as DIC, immune thrombocytopenia, thrombotic microangiopathies including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome, and drug-induced thrombocytopenia. The presumptive diagnosis of HIT is made by the so called 4Ts scoring system developed by Cuker, et al. [6]. Herein we report the first case, at the best of our knowledge, of suspected HIT in a patient positive for SARS-CoV-2. Case Description On March 14, 2020 a 79-years-old man was admitted to our Department due to dry cough and fever. His wife and daughter were SARS-CoV-2 positive. His nasopharyngeal swab-test for SARS-CoV-2 was positive and he was in quarantine at home. His past medical history included non-insulin-dependent diabetes mellitus, right carotid endarterectomy, colorectal cancer and gastric ulcer. He was taking aspirin, furosemide, bisoprolol and linagliptin. On physical

Case Report: Heparin-induced thrombocytopenia during COVID-19 outbreak: the importance of scoring system in differentiating with sepsis-induced coagulopathy

“…It has been reported that 30–60% of patients can suffer venous events while 15–20% can suffer arterial events while bleeding manifestation is rare. 2 , 5 , 9 , 10 …”

“…The measurement of PF4/H is not commonly checked in our center, so we use the scoring system to measure the possibility of HIT. 2 , 5 , 7 , 9 , 11 …”

“…Heparin is the agent of choice for anticoagulation, especially in those with severe COVID-19 manifestation. 2 – 5 …”

“…It can also develop rapidly within 24 hours after re-exposure of heparin in some patients with a recent heparin administration history. 2 , 6 , 7 An increasing incidence of HIT occurs among COVID-19 patients, explained by exacerbated immune reactions and probably by an increased release of PF4, linked to platelet activation. However, the underlying pathophysiology of increased HIT risk and thrombosis risk in COVID-19 patients is not yet well understood.…”