COVID-19 versus HIT hypercoagulability
Open accessAbstract
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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Incidence and consequences of systemic arterial thrombotic events in COVID-19 patientsPreprint
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Portal-splenic-mesenteric venous thrombosis in COVID-19 patients: a systematic review
Gomes, R. Z., Salina, M. V. J., Pironatto, V. H. M., Lepinski, J. K., Gueiber, T. D., Juliatto, B. M. S., Prestes, M. Z., & Martins, C. M. (2025) · Jornal Vascular Brasileiro · doi:10.1590/1677-5449.202301282 · Cited by 2 · see citing works
- Authors
- Warkentin, T. E., & Kaatz, S.
- Affiliations
- Hamilton General Hospital (CA)
- Henry Ford Hospital (US)
- Corresponding author
- Warkentin, Theodore E.
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 196
- Pages
- 38-51
- ISSN
- 0049-3848 (ISSN-L)
- PMC
- PMC7416717
- OpenAlex
- W3048096829
- Cited by
- 57
- References
- 132
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 8 · 2022: 15 · 2021: 22 · 2020: 4
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thrombosis Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Janssen Canada
- Bristol-Myers Squibb Canada
- Topics
- Health Sciences › Medicine › Surgery › Heparin-Induced Thrombocytopenia and Thrombosis
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- COVID-19 pandemic, heparin-induced thrombocytopenia, hypercoagulability, thrombosis, deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, thromboprophylaxis, heparin, anticoagulation, SARS-CoV-2, intensive care unit patients, thrombocytopenia
- MeSH terms
- COVID-19, SARS-CoV-2, Disseminated Intravascular Coagulation, Heparin, Humans, Thrombocytopenia, Thrombosis, Thrombophilia
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