Heparin-induced thrombocytopenia is associated with a high risk of mortality in critical COVID-19 patients receiving heparin-involved treatment

  1. Xuan Liu
  2. Xiaopeng Zhang
  3. Yongjiu Xiao
  4. Ting Gao
  5. Guangfei Wang
  6. Zhongyi Wang
  7. Zhang Zhang
  8. Yong Hu
  9. Qincai Dong
  10. Songtao Zhao
  11. Li Yu
  12. Shuwei Zhang
  13. Hongzhen Li
  14. Kaitong Li
  15. Wei Chen
  16. Xiuwu Bian
  17. Qing Mao
  18. Cheng Cao
1 evaluations Published on
Read the full article Related papers
This article on Sciety

Abstract

Background

Coronavirus infectious disease 2019 (COVID-19) has developed into a global pandemic. It is essential to investigate the clinical characteristics of COVID-19 and uncover potential risk factors for severe disease to reduce the overall mortality rate of COVID-19.

Methods

Sixty-one critical COVID-19 patients admitted to the intensive care unit (ICU) and 93 severe non-ICU patients at Huoshenshan Hospital (Wuhan, China) were included in this study. Medical records, including demographic, platelet counts, heparin-involved treatments, heparin-induced thrombocytopenia-(HIT) related laboratory tests, and fatal outcomes of COVID-19 patients were analyzed and compared between survivors and nonsurvivors.

Findings

Sixty-one critical COVID-19 patients treated in ICU included 15 survivors and 46 nonsurvivors. Forty-one percent of them (25/61) had severe thrombocytopenia, with a platelet count (PLT) less than 50×109/L, of whom 76% (19/25) had a platelet decrease of >50% compared to baseline; 96% of these patients (24/25) had a fatal outcome. Among the 46 nonsurvivors, 52·2% (24/46) had severe thrombocytopenia, compared to 6·7% (1/15) among survivors. Moreover, continuous renal replacement therapy (CRRT) could induce a significant decrease in PLT in 81·3% of critical CRRT patients (13/16), resulting in a fatal outcome. In addition, a high level of anti-heparin-PF4 antibodies, a marker of HIT, was observed in most ICU patients. Surprisingly, HIT occurred not only in patients with heparin exposure, such as CRRT, but also in heparin-naïve patients, suggesting that spontaneous HIT may occur in COVID-19.

Interpretation

Anti-heparin-PF4 antibodies are induced in critical COVID-19 patients, resulting in a progressive platelet decrease. Exposure to a high dose of heparin may trigger further severe thrombocytopenia with a fatal outcome. An alternative anticoagulant other than heparin should be used to treat COVID-19 patients in critical condition.

Funding

This investigation was supported by grants 2016CB02400 and 2017YFC1201103 from the National Major Research and Development Program of China.

Related articles

Related articles are currently not available for this article.