A case of severe COVID-19 with pulmonary thromboembolism related to heparin-induced thrombocytopenia during prophylactic anticoagulation therapy

Kosaku Sasaki, Masayuki Murata, Keiji Nakamura, Yuji Matsumoto, Yuko Nakashima, Sho Yamasaki, Azusa Ota, Satoshi Hiramine, Koji Takayama, Hiroaki Ikezaki, Kazuhiro Toyoda, Eiichi Ogawa, Nobuyuki Shimono

Research output: Contribution to journalArticlepeer-review

Abstract

A 53-year-old male Japanese patient with COVID-19 was admitted to our hospital after his respiratory condition worsened on day 9 of the disease. With the diagnosis of severe COVID-19, treatment with remdesivir, dexamethasone, and unfractionated heparin was started for the prevention of thrombosis. Although the patient's respiratory status data improved after treatment, severe respiratory failure persisted. Thrombocytopenia and D-dimer elevation were observed on day 8 after heparin therapy initiation. Heparin-induced thrombocytopenia (HIT) antibody measured by immunological assay was positive, and contrast computed tomography showed pulmonary artery thrombus. The patient was diagnosed with HIT because the pre-test probability score (4Ts score) for HIT was 7 points. Heparin was changed to apixaban, a direct oral anticoagulant, which resulted in a reduction of the pulmonary thrombus and improvement of the respiratory failure. In patients with COVID-19, anticoagulant therapy with heparin requires careful monitoring of thrombocytopenia and elevated D-dimer as possible complications related to HIT. (151/250 words).

Original languageEnglish
Pages (from-to)1208-1211
Number of pages4
JournalJournal of Infection and Chemotherapy
Volume28
Issue number8
DOIs
Publication statusPublished - Aug 2022

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

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