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2 . 2022

Heparin-induced thrombocytopenia and COVID-19: simplified rule of diagnosis and treatment algorithm

Abstract

Introduction. Thrombocytopenia significantly increases the risk of complications and mortality during surgical interventions, especially in general surgical, cardiac, traumatological and vascular patients. The causes of it in the postoperative period are more often blood loss, hemodilution, sepsis, as well as the use of heparins. Heparin-induced thrombocytopenia (HIT) has an immunospecific genesis, increases the risk of paradoxical thrombosis and the mortality of hospitalized patients, including COVID‑19 patients.

The spontaneous HIT syndrome is described during vaccination against COVID‑19 and mechanical pneumocompression. The diagnosis of HIT is complicated by the inaccessibility and high cost of the method for determining HIT-antibodies, the complexity and low specificity of the existing Risk Scales (the 4T scale, the HEP scale, the Scale for detecting HIT after coronary artery bypass grafting). The aim of the work was to determine the prevalence of HIT in a multidisciplinary hospital, as well as to improve its diagnosis and treatment through the practical implementation of the original diagnosis rule and the algorithm for managing patients with HIT.

Material and methods. The laboratory database for 2013–2015 of a multidisciplinary hospital with 540 beds with an analysis of cases of severe thrombocytopenia was retrospectively analyzed. Since 2014, hospital doctors have been informed about the original rule and the algorithm for managing patients with HIT. The frequency of cases of suspected HIT and its complications were analyzed in dynamics over 3 years by taking into account the number of such patients in hospital departments, including intensive care units.

Results. Severe thrombocytopenia (<100×109/L) was detected in 5018 blood samples obtained from 950 patients (367 + 288 + 295 respectively, in 2013, 2014 and 2015) out of 75 123 treated during this period, which was 1.3%. 2 groups of patients were identified: patients with suspected HIT (who received heparins) and those who did not receive heparins. The dynamics showed the decrease in the number of severe thrombocytopenia cases in hospital patients receiving heparins, the decrease in their number in intensive care units with the significant decrease in their mortality. The positive results of the introduction of the rule and the algorithm were especially noticeable in cardiac surgery, traumatology, urology and vascular surgery. Severe thrombocytopenia (<100×109/L) in COVID‑19 was detected in 168 patients of intensive care units out of 1878 patients treated in the hospital with COVID‑19, which was 8.9%.

Conclusion. The introduction of the original rule for the diagnosis of HIT “100–5–100” and the algorithm for managing of such patients simplified the diagnosis and led to a decrease in the frequency of complications of HIT, including fatal outcomes. Given the almost sevenfold increase in the frequency of suspected HIT in COVID‑19 compared to non-infectious patients, the using of described principles of diagnosis and treatment of HIT could improve the outcomes of this disease as well.

Keywords:heparin; thrombocytopenia; heparin-induced thrombocytopenia; COVID 19; rule for rapid diagnosis of heparin-induced thrombocytopenia

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Semigolovskii N.Yu., Drygin A.N., Levchuk A.L., Semigolovskii S.N., Simutis I.S. Heparin-induced thrombocytopenia and COVID‑19: simplified rule of diagnosis and treatment algorithm. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2022; 10 (2): 18–27. DOI: https://doi.org/10.33029/2309-1908-2022-10-12-18-27 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Andrey G. Obrezan
MD, Professor, Head of the Hospital Therapy Department of the Saint Petersburg State University, Chief Physician of SOGAZ MEDICINE Clinical Group, St. Petersburg, Russian Federation
Вскрытие
МКК
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