Heparin induced thrombocytopenia antibodies in Covid‐19

Patell, Rushad; Khan, Adeel; Bogue, Thomas; Merrill, Mwanasha; Koshy, Anita G.; Bindal, Poorva; Joyce, Robin; Aird, William C.; Neuberg, Donna; Bauer, Kenneth A.; Zwicker, Jeffrey I.

doi:10.1002/ajh.25935

Cited by 51 publications

(70 citation statements)

References 8 publications

(1 reference statement)

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“…Heparin is often used during the treatment of COVID-19, and heparin-induced thrombocytopenia (HIT) is often reported [ 54 , 55 ]. This diagnosis should not be delayed, and proactive measurement of HIT antibodies is needed.…”

Section: Decreased Platelet and Lymphocyte Countsmentioning

confidence: 99%

COVID-19-associated coagulopathy and disseminated intravascular coagulation

2020

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The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in d -dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by d -dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID-19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study

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Section: Decreased Platelet and Lymphocyte Countsmentioning

confidence: 99%

COVID-19-associated coagulopathy and disseminated intravascular coagulation

2020

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“…Patell and coworkers [ 112 ] reported 5 patients with possible HIT—based upon suspicious platelet count decline and a positive latex immunoturbidimetric assay (LIA) for anti-PF4/heparin antibodies—among 88 COVID-19 patients who received at least 5 days of UFH (median, 11 days of UFH exposure). This corresponded to a cumulative incidence of LIA positivity of 12% at 25 days (95%CI, 4% to 26%).…”

Section: Hit As a Potential Complication Of Covid-19mentioning

confidence: 99%

COVID-19 versus HIT hypercoagulability

Warkentin

Kaatz

2020

Thrombosis Research

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A striking feature of COVID-19 is the high frequency of thrombosis, particularly in patients who require admission to intensive care unit because of respiratory complications (pneumonia/adult respiratory distress syndrome). The spectrum of thrombotic events is wide, including in situ pulmonary thrombosis, deep-vein thrombosis and associated pulmonary embolism, as well as arterial thrombotic events (stroke, myocardial infarction, limb artery thrombosis). Unusual thrombotic events have also been reported, e.g., cerebral venous sinus thrombosis, mesenteric artery and vein thrombosis. Several hematology abnormalities have been observed in COVID-19 patients, including lymphopenia, neutrophilia, thrombocytopenia (usually mild), thrombocytosis, elevated prothrombin time and partial thromboplastin times (the latter abnormality often indicating lupus anticoagulant phenomenon), hyperfibrinogenemia, elevated von Willebrand factor levels, and elevated fibrin d -dimer. Many of these abnormal hematologic parameters—even as early as the time of initial hospital admission—indicate adverse prognosis, including greater frequency of progression to severe respiratory illness and death. Progression to overt disseminated intravascular coagulation in fatal COVID-19 has been reported in some studies, but not observed in others. We compare and contrast COVID-19 hypercoagulability, and associated increased risk of venous and arterial thrombosis, from the perspective of heparin-induced thrombocytopenia (HIT), including the dilemma of providing thromboprophylaxis and treatment recommendations when available data are limited to observational studies. The frequent use of heparin—both low-molecular-weight and unfractionated—in preventing and treating COVID-19 thrombosis, means that vigilance for HIT occurrence is required in this patient population.

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“…Saegel et al [9] found that in the critical care setting or in patients at high risk for bleeding, initial dose reduction of argatroban may be necessary. In fact, Patell et al described three of five patients diagnosed as HIT with COVID-19 developed major hemorrhagic events after introducing direct thrombin inhibitors [10].…”

mentioning

confidence: 99%