Madala Samragnyi, Krzyzak Michael, Dehghani Shabnam
Medicine, Staten Island University Hospital, Staten Island, USA.
Medicine, Touro College of Osteopathic Medicine, New York, USA.
Cureus. 2021 Feb 18;13(2):e13425. doi: 10.7759/cureus.13425.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a viral respiratory illness initially described in Wuhan, China, and was declared a pandemic by World Health Organization (WHO) in 2020, and the disease is named coronavirus disease (COVID-19). SARS-CoV2 is known to cause fever, cough, fatigue, and acute respiratory distress syndrome. As more patients become infected, extrapulmonary manifestations came to rise and hypercoagulability is one among those. COVID-19 could predispose patients to both venous and arterial thromboembolic events which are commonly treated with unfractionated heparin or low molecular weight heparin (LMWH). The treatment of patients who develop heparin-induced thrombocytopenia (HIT) while being treated with heparin or LMWH for COVID-induced thromboembolic complications is challenging. We describe a patient admitted to the hospital with COVID-19 pneumonia, found to have a cerebrovascular event treated with unfractionated heparin. She also received therapeutic LMWH for anticoagulation on day 1 of presentation due to atrial fibrillation. She was diagnosed with HIT and was found to have a pulmonary embolism, aortic arch mural thrombus, and arterial thrombi in the lower extremities. As more recent studies showed HIT antibodies in COVID-19 patients who are naive for heparin-based products, COVID-19 may be an independent risk factor for the development of HIT. The role of COVID-19 in the development of HIT is uncertain. High vigilance is required to diagnose and initiate treatment for HIT early in the disease course as it can be life-threatening.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发了一种病毒性呼吸道疾病，最初在中国武汉被发现，并于2020年被世界卫生组织（WHO）宣布为大流行病，该疾病被命名为冠状病毒病（COVID-19）。已知SARS-CoV-2会导致发热、咳嗽、疲劳和急性呼吸窘迫综合征。随着越来越多的患者被感染，肺外表现逐渐增多，高凝状态就是其中之一。COVID-19可能使患者易发生静脉和动脉血栓栓塞事件，这些事件通常用普通肝素或低分子肝素（LMWH）进行治疗。对于在因COVID-19引起的血栓栓塞并发症而接受肝素或LMWH治疗时发生肝素诱导的血小板减少症（HIT）的患者，治疗具有挑战性。我们描述了一名因COVID-19肺炎入院的患者，该患者被发现发生了脑血管事件，接受了普通肝素治疗。由于心房颤动，她在就诊第1天还接受了治疗性LMWH抗凝。她被诊断为HIT，并被发现患有肺栓塞、主动脉弓壁血栓和下肢动脉血栓。由于最近的研究表明，在未使用过肝素类产品的COVID-19患者中也存在HIT抗体，COVID-19可能是发生HIT的一个独立危险因素。COVID-19在HIT发生中的作用尚不确定。由于HIT可能危及生命，因此在疾病过程中需要高度警惕，以便早期诊断并开始治疗。
