Cited by 57Heparin-Induced Thrombocytopenia and ThrombosisCOVID-19 Clinical Research StudiesVenous Thromboembolism Diagnosis and Management

COVID-19 versus HIT hypercoagulability

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Warkentin, Theodore E., Kaatz, Scott·2020·Thrombosis Research

Abstract

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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Crossref · 10.1016/j.thromres.2020.08.017

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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)
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
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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