Prevalence and clinical implication of thrombocytopenia and heparin-induced thrombocytopenia in patients who are critically ill with COVID-19

Reut Kassif Lerner*, Dor Lotan, Daniel Oren, Edward Itelman, Yuval Neeman, Shahar Dekel, Eyal Heller, Arsalan Abu-Much, Noya Shilo, Rami Gilead, Evyatar Hubara, Meir Mouallem, Yael Haviv, Alexander Kogan, Haim Mayan, Itai M. Pessach

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

As the COVID-19 pandemic continues to evolve, different clinical manifestations are better understood and studied. These include various haematologic disorders that have been shown to be associated with increased morbidity and mortality. We studied the prevalence of one unusual manifestation, heparin-induced thrombocytopenia (HIT) and its clinical implications in patients who are severely ill with COVID-19 in a single tertiary centre in Israel. The presence of thrombocytopenia, disseminated intravascular coagulation (DIC) and HIT, and their association with clinical course and outcomes were studied. One-hundred and seven patients with COVID-19 were included. Fifty-seven (53.2%) patients developed thrombocytopenia, which was associated with the worst outcomes (ventilation, DIC and increased mortality). Sixteen (28.0%) patients with thrombocytopenia were positive for HIT, all of which were supported by extracorporeal devices. HIT was independently associated with ventilation days, blood product transfusions, longer hospitalisation and mortality. Platelet abnormalities and HIT are common in patients who are critically ill with COVID-19 and are associated with the worst clinical outcomes. The mechanisms underlying HIT in COVID-19 are yet to be studied; HIT may contribute to the dysregulated immunologic response associated with COVID-19 critical illness and may play a significant part in the coagulopathy seen in these patients. As many patients with COVID-19 require aggressive thromboprophylaxis, further understanding of HIT and the implementation of appropriate protocols are important.

Original languageEnglish
Pages (from-to)403-408
Number of pages6
JournalClinical Medicine, Journal of the Royal College of Physicians of London
Volume22
Issue number5
DOIs
StatePublished - Sep 2022
Externally publishedYes

Keywords

  • COVID-19
  • ECMO
  • HIT
  • thrombocytopenia

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