Heparin-induced thrombocytopenia during anticoagulation therapy for COVID-19-related pulmonary embolism: A case report.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE

Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins

Thrombocytopenia*/chemically induced ; Pulmonary Embolism*/drug therapy ; COVID-19*/complications ; Anticoagulants*/adverse effects ; Anticoagulants*/therapeutic use ; Heparin*/adverse effects ; Heparin*/therapeutic use; Humans ; Male ; Aged, 80 and over ; SARS-CoV-2 ; Pipecolic Acids/therapeutic use ; Platelet Count ; Sulfonamides/therapeutic use ; Arginine/analogs & derivatives ; Nadroparin/therapeutic use ; Nadroparin/adverse effects

Rationale: One of the main characteristics of COVID-19 is the high incidence of venous thromboembolism, particularly pulmonary embolism. Anticoagulation therapy is the primary treatment for pulmonary embolism. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse reaction to heparin that occurs during its use of heparin drugs. The main clinical manifestation is a decrease in platelet count, which can lead to the formation of arterial and venous thrombosis and, in severe cases, even death. Herein, we present a case of HIT that occurred during anticoagulation therapy for COVID-19, complicated by pulmonary embolism.
Patient Concerns: An 86-year-old man with COVID-19 experienced a significant decrease in platelet count and progression of venous thrombosis in the lower extremities during anticoagulation therapy with nadroparin.
Diagnoses: The 4T score was 6; therefore, HIT was considered.
Interventions and Outcomes: All heparin-based drugs were discontinued, and argatroban was administered as anticoagulation therapy. The patient's platelet count was monitored, and it gradually returned to normal.
Lessons: Clinicians should remain vigilant to venous thromboembolism for COVID-19 patients even after recovery. During anticoagulant therapy, if thrombocytopenia occurs, HIT should be considered due to its high mortality rate. The 4T scoring system was used for the initial assessment. HIT antibodies can be detected, if necessary, to assist in diagnosis and reduce the occurrence of severe HIT. In the future, by detecting certain biomarkers, we can screen out patients with HIT who are more prone to thrombotic events, thereby minimizing the risk of bleeding caused by anticoagulation.
Competing Interests: The authors have no conflicts of interest to declare.
(Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

J Clin Pharm Ther. 2022 Jan;47(1):112-118. (PMID: 34704283)
N Engl J Med. 2021 Aug 26;385(9):790-802. (PMID: 34351721)
Ann Intern Med. 2020 Aug 18;173(4):268-277. (PMID: 32374815)
J Thromb Thrombolysis. 2023 Aug;56(2):241-252. (PMID: 37219826)
Natl Sci Rev. 2020 Sep;7(9):1414-1418. (PMID: 34192086)
N Engl J Med. 2015 Jul 16;373(3):252-61. (PMID: 26176382)
Br J Haematol. 2012 Dec;159(5):528-40. (PMID: 23043677)
J Thromb Haemost. 2016 Jun;14(6):1206-10. (PMID: 27061271)
Ann Thorac Surg. 2021 Jul;112(1):32-37. (PMID: 33217393)
N Engl J Med. 2020 Oct 22;383(17):1675-1678. (PMID: 33085867)
J Cardiol Cases. 2023 Nov 22;29(2):93-96. (PMID: 38362576)
Chest. 2020 Sep;158(3):1143-1163. (PMID: 32502594)
Thromb J. 2023 Sep 19;21(1):100. (PMID: 37726772)
J Clin Pharmacol. 2020 Oct;60(10):1362-1366. (PMID: 32519800)
Chest. 2012 Feb;141(2 Suppl):e495S-e530S. (PMID: 22315270)
Pharmacotherapy. 2000 Aug;20(8):974-80. (PMID: 10939559)

0 (Anticoagulants)
9005-49-6 (Heparin)
0 (Pipecolic Acids)
IY90U61Z3S (argatroban)
0 (Sulfonamides)
94ZLA3W45F (Arginine)
0 (Nadroparin)

Date Created: 20241210 Date Completed: 20241210 Latest Revision: 20241212

20241212

PMC11630917

10.1097/MD.0000000000040732

39654231