Heparin-induced thrombocytopenia: pathophysiology, diagnosis and treatment

Hvas, Anne‐Mette; Favaloro, Emmanuel J.; Hellfritzsch, Maja

doi:10.1080/17474086.2021.1905512

Cited by 24 publications

(27 citation statements)

References 87 publications

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“…Some researchers find a high level of “HIT” in COVID‐19‐infected patients, but these findings need to be tempered by methodological flaws, where patients were either not fully worked up, or else key details were missing. It needs to be noted that in non‐COVID‐19 literature, many patients may be found to have PF4/H antibodies, but most of these will not develop pathological HIT 56 . Moreover, a high level of PF4/H antibodies (especially as detected by ELISA) will not be positive by a functional assay such as SRA 20,24 …”

Section: Discussionmentioning

confidence: 99%

The complicated relationships of heparin‐induced thrombocytopenia and platelet factor 4 antibodies with COVID‐19

Favaloro

Henry

Lippi

2021

Int J Lab Hematology

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COVID‐19 (coronavirus disease 2019) represents a prothrombotic disorder, and there have been several reports of platelet factor 4/heparin antibodies being present in COVID‐19‐infected patients. This has thus been identified in some publications as representing a high incidence of heparin‐induced thrombocytopenia (HIT), whereas in others, findings have been tempered by general lack of functional reactivity using confirmation assays of serotonin release assay (SRA) or heparin‐induced platelet aggregation (HIPA). Moreover, in at least two publications, data are provided suggesting that antibodies can arise in heparin naïve patients or that platelet activation may not be heparin‐dependent. From this literature, we would conclude that platelet factor 4/heparin antibodies can be observed in COVID‐19‐infected patients, and they may occur at higher incidence than in historical non‐COVID‐19‐infected cohorts. However, the situation is complex, since not all platelet factor 4/heparin antibodies may lead to platelet activation, and not all identified antibodies are heparin‐dependent, such that they do not necessarily reflect “true” HIT. Most recently, a “HIT‐like” syndrome has reported in patients who have been vaccinated against COVID‐19. Accordingly, much more is yet to be learnt about the insidious disease that COVID‐19 represents, including autoimmune outcomes in affected patients.

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Section: Discussionmentioning

confidence: 99%

The complicated relationships of heparin‐induced thrombocytopenia and platelet factor 4 antibodies with COVID‐19

Favaloro

Henry

Lippi

2021

Int J Lab Hematology

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“…7 Although it is rare, UFH can cause heparin induced thrombocytopenia (HIT) in 0.2% to 5% of adult patients. 8 Heparin induced thrombocytopenia is more common in adults than pediatrics and is a potentially life-threatening immune-mediated prothrombotic disorder, especially in patients exposed multiple times to heparin. 9,10 Alternative anticoagulants, such as direct thrombin inhibitors (DTIs), are being increasingly used off-label for both pediatric and adult ECMO patients.…”

Section: Anticoagulantsmentioning

confidence: 99%

2021 ELSO Adult and Pediatric Anticoagulation Guidelines

et al. 2022

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Disclaimer: These guidelines for adult and pediatric anticoagulation for extracorporeal membrane oxygenation are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

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“…Directly switching to DOACs for HIT appears to be effective in clinically stable patients, as in our case. Patients with thrombotic HIT are recommended to receive a non-heparin anticoagulant for a total of 3 months [ 22 ].…”

Section: Discussionmentioning

confidence: 99%