Heparin-Induced Thrombocytopenia in COVID-19
Heparin-Induced Thrombocytopenia in COVID-19
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DOI：
10.1177/2324709620944091
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发表时间：
2020-07-01
影响因子：
1.2
通讯作者：
Zia, Maryam
中科院分区：
文献类型：
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作者：
Lingamaneni, Prasanth;Gonakoti, Sriram;Zia, Maryam
COVID-19（2019冠状病毒病）感染是一种高度促血栓形成状态，由凝血级联反应失调引起。因此，在这些患者中强烈建议血栓预防，一些专家甚至提倡治疗剂量以预防血栓栓塞事件。肝素诱导的血小板减少症（HIT）是肝素治疗的常见并发症。在这篇文章中，我们报告了一例COVID-19患者的HIT病例。一名63岁男性因干咳和腹泻1周就诊。他的鼻咽COVID-19逆转录聚合酶链反应呈阳性。入院时，血小板计数和肝功能检查均在正常范围内。住院期间，患者发生右股深静脉血栓形成，并开始接受抗凝治疗。由于呼吸衰竭恶化，患者接受插管和机械通气。住院第11 - 12天，血小板计数从304 000降至96 000个细胞/μ L。他的HIT预测概率较高，4 T评分为6分，抗PF 4/肝素抗体阳性。停用肝素滴注，改用阿加曲班。血清素释放试验最终返回阳性，这证实了HIT的诊断。我们还通过4例HIT抗体假阳性病例讨论了COVID-19中HIT的潜在过度诊断。
COVID-19 (coronavirus disease-2019) infection is a highly prothrombotic state, resulting from a dysregulation of the coagulation cascade. Therefore, thromboprophylaxis is strongly recommended in these patients, with some experts even advocating for therapeutic dosing to prevent thromboembolic events. Heparin-induced thrombocytopenia (HIT) is a well-known complication of heparin therapy. In this article, we report a case of HIT in a patient with COVID-19. A 63-year-old male presented with 1 week of dry cough and diarrhea. He had a positive nasopharyngeal COVID-19 reverse-transcriptase-polymerase chain reaction. On admission, the platelet count and liver function tests were within normal limits. During his hospitalization, he developed a right femoral deep venous thrombosis and was started on therapeutic anticoagulation. Due to worsening respiratory failure, he was intubated and mechanically ventilated. Between days 11 and 12 of hospitalization, platelet count dropped from 304 000 to 96 000 cells/mu L. He had a high pretest probability for HIT with a 4T score of 6 and a positive anti-PF4/heparin antibody. Heparin drip was discontinued and was switched to argatroban. The serotonin release assay eventually returned positive, which confirmed the diagnosis of HIT. We also discuss potential overdiagnosis of HIT in COVID-19 through 4 cases with false-positive HIT antibodies.