Clinical and laboratory characteristics of hospitalized patients with COVID-19 with confirmed HIT
| Case . | Age (y), sex . | Severity of COVID-19 . | Indication of heparin . | Type and dose of heparin . | Duration of heparin to HIT diagnosis (d) . | Initial platelet count (x109 /L) . | Nadir platelet count (x109 /L) . | Thrombosis after heparin initiation . | 4T score . | Screening test . | Confirmatory test . | Non-heparin anticoagulants . | Platelet response after HIT treatment . | Outcomes of patients as reported . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 126 | 70, M | ICU (MV, ARDS) | DVT prophylaxis | UFH; prophylaxis | 20 | 438 | 90 | PE | 6 | ELISA (OD 2.0) | SRA, positive (48%) | Bivalirudin | Death shortly after HIT diagnosis | Death |
| 227 | 63, M | ICU (MV) | DVT prophylaxis | LMWH; prophylaxis | 12 | 304 | 96 | DVT | 6 | ELISA (OD 1.2) | SRA, positive (49%) | Argatroban | Death shortly after HIT diagnosis | Death |
| 328 | 61. F | ICU (RRT) | RRT | UFH; prophylactic | N/A | N/A | 37 | N/A | 4 | ELISA (OD 0.95) | SRA, positive | N/A | N/A | N/A |
| 429 | 68, F | ICU | AF | UFH; therapeutic | 7 | 416 | <5 | None | 4 | LITA (1.8 U/mL) | SRA, positive | Argatroban, bivalirudin | Platelet recovery | Alive |
| 529 | 63, M | ICU | STEMI | UFH; therapeutic | 6 | 154 | 51 | Splenic infarct and cerebral infarct | 8 | LITA (1.6 U/mL) | SRA, borderline positive | Argatroban | Platelet recovery | Death |
| 629 | 49, M | ICU | COVID pneumonia | UFH; therapeutic | 12 | 176 | 25 | None | 6 | LITA (1.9 U/mL) | SRA, borderline positive | Argatroban | Platelet recovery | Alive |
| 730 | 62. F | ICU (MV, ECMO) | PE, ECMO | UFH; therapeutic | 16 | 237 | 29 | None | 3 | ELISA (OD 1.8) | HIPA, positive | Argatroban | Platelet recovery, discharge from hospital | Alive |
| 830 | 38, M | ICU (MV, ECMO) | ECMO | UFH; therapeutic | 21 | 248 | 50 | None | 4 | ELISA (OD 1.6) | HIPA, positive | Argatroban | Platelet recovery, discharge from hospital | Alive |
| 931 | 62, M | ICU (MV) | VTE prophylaxis | LMWH and UFH flush; prophylactic | 17 | 412 | 91 | PE | 4 | ELISA (OD 1.1) | HIPA, positive | Bivalirudin | Platelet recovery | Alive |
| 1032 | 46, M | ICU (ARDS. MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 16 | 61 | 33 | Multiple DVT | 6 | CIA (46 U/mL) | HIPA, positive | Argatroban | Platelet recovery/ discharge from ICU | Discharge from ICU |
| 1132 | 50, M | ICU (ARDS, MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 13 | 243 | 73 | Intracardiac thrombus, ECMO membrane thrombosis | 6 | CIA (11 U/mL) | HIPA, positive | Argatroban | Platelet recovery/ still in ICU | Still in ICU |
| 1232 | 43, F | ICU (ARDS, MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 15 | 160 | 48 | Multiple DVT, ECMO pump thrombosis | 6 | CIA (39 U/ML) | HIPA, positive | Argatroban | Platelet recovery/ still in ICU | Still in ICU |
| 1332 | 63, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 14 | 191 | 56 | Stroke | 4 | CIA (60 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1432 | 59, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 9 | 161 | 62 | DVT | 5 | CIA (4 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from ICU | Discharge from ICU |
| 1532 | 57, M | ICU (ARDS) | Clinical trial (COAG-COVID)a | UFH; therapeutic | 11 | 159 | 39 | None | 5 | CIA (21 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1632 | 69, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | UFH; therapeutic | 16 | 215 | 107 | None | 4 | CIA (2 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1733 | 64, M | ICU | VTE prophylaxis | LMWH; prophylactic | 18 | 223 | 67 | DVT | 6 | PaGIA positive, ELISA IgG (OD 2.4) | HIPLA, positive (75%), SRA, positive (94% at 0.1 U/mL and 103% at 0.5 U/mL heparin) | Argatroban (13 d), danaparoid (19 d), apixaban at discharge | Platelet recovery, discharge from hospital | Alive |
| 1837 | 63, M | ICU (RRT) | RRT | LMWH and UFH; NA | N/A | N/A | 67 | PE | ≥4 | ELISA IgG (OD 0.62) | SRA, positive | Argatroban | N/A | Death |
| 1938 | 65, F | Non-ICU | AF | LMWH and UFH; therapeutic | 12 | 290 | 63 | Stroke, PE, iliac and femoral artery thrombosis, | 6 | CIA (9.7 U/mL) | SRA, positive (94%) | Argatroban, apixaban | Platelet recovery, discharge from hospital | Alive |
| 2039 | 65, M | Non-ICU | N/A | N/A | N/A (8 d after diagnosis of COVID-19) | N/A | 6 | DVT, PE (at presentation) | N/A | NR, positive | SRA, positive | Argatroban, apixaban, IVIG | Platele recovery, discharge from hospital | Alive |
| Case . | Age (y), sex . | Severity of COVID-19 . | Indication of heparin . | Type and dose of heparin . | Duration of heparin to HIT diagnosis (d) . | Initial platelet count (x109 /L) . | Nadir platelet count (x109 /L) . | Thrombosis after heparin initiation . | 4T score . | Screening test . | Confirmatory test . | Non-heparin anticoagulants . | Platelet response after HIT treatment . | Outcomes of patients as reported . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 126 | 70, M | ICU (MV, ARDS) | DVT prophylaxis | UFH; prophylaxis | 20 | 438 | 90 | PE | 6 | ELISA (OD 2.0) | SRA, positive (48%) | Bivalirudin | Death shortly after HIT diagnosis | Death |
| 227 | 63, M | ICU (MV) | DVT prophylaxis | LMWH; prophylaxis | 12 | 304 | 96 | DVT | 6 | ELISA (OD 1.2) | SRA, positive (49%) | Argatroban | Death shortly after HIT diagnosis | Death |
| 328 | 61. F | ICU (RRT) | RRT | UFH; prophylactic | N/A | N/A | 37 | N/A | 4 | ELISA (OD 0.95) | SRA, positive | N/A | N/A | N/A |
| 429 | 68, F | ICU | AF | UFH; therapeutic | 7 | 416 | <5 | None | 4 | LITA (1.8 U/mL) | SRA, positive | Argatroban, bivalirudin | Platelet recovery | Alive |
| 529 | 63, M | ICU | STEMI | UFH; therapeutic | 6 | 154 | 51 | Splenic infarct and cerebral infarct | 8 | LITA (1.6 U/mL) | SRA, borderline positive | Argatroban | Platelet recovery | Death |
| 629 | 49, M | ICU | COVID pneumonia | UFH; therapeutic | 12 | 176 | 25 | None | 6 | LITA (1.9 U/mL) | SRA, borderline positive | Argatroban | Platelet recovery | Alive |
| 730 | 62. F | ICU (MV, ECMO) | PE, ECMO | UFH; therapeutic | 16 | 237 | 29 | None | 3 | ELISA (OD 1.8) | HIPA, positive | Argatroban | Platelet recovery, discharge from hospital | Alive |
| 830 | 38, M | ICU (MV, ECMO) | ECMO | UFH; therapeutic | 21 | 248 | 50 | None | 4 | ELISA (OD 1.6) | HIPA, positive | Argatroban | Platelet recovery, discharge from hospital | Alive |
| 931 | 62, M | ICU (MV) | VTE prophylaxis | LMWH and UFH flush; prophylactic | 17 | 412 | 91 | PE | 4 | ELISA (OD 1.1) | HIPA, positive | Bivalirudin | Platelet recovery | Alive |
| 1032 | 46, M | ICU (ARDS. MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 16 | 61 | 33 | Multiple DVT | 6 | CIA (46 U/mL) | HIPA, positive | Argatroban | Platelet recovery/ discharge from ICU | Discharge from ICU |
| 1132 | 50, M | ICU (ARDS, MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 13 | 243 | 73 | Intracardiac thrombus, ECMO membrane thrombosis | 6 | CIA (11 U/mL) | HIPA, positive | Argatroban | Platelet recovery/ still in ICU | Still in ICU |
| 1232 | 43, F | ICU (ARDS, MV, ECMO) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 15 | 160 | 48 | Multiple DVT, ECMO pump thrombosis | 6 | CIA (39 U/ML) | HIPA, positive | Argatroban | Platelet recovery/ still in ICU | Still in ICU |
| 1332 | 63, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 14 | 191 | 56 | Stroke | 4 | CIA (60 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1432 | 59, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | LMWH and UFH; therapeutic | 9 | 161 | 62 | DVT | 5 | CIA (4 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from ICU | Discharge from ICU |
| 1532 | 57, M | ICU (ARDS) | Clinical trial (COAG-COVID)a | UFH; therapeutic | 11 | 159 | 39 | None | 5 | CIA (21 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1632 | 69, M | ICU (ARDS, MV) | Clinical trial (COAG-COVID)a | UFH; therapeutic | 16 | 215 | 107 | None | 4 | CIA (2 U/mL) | HIPA, positive | Danaparoid | Platelet recovery, discharge from hospital | Alive |
| 1733 | 64, M | ICU | VTE prophylaxis | LMWH; prophylactic | 18 | 223 | 67 | DVT | 6 | PaGIA positive, ELISA IgG (OD 2.4) | HIPLA, positive (75%), SRA, positive (94% at 0.1 U/mL and 103% at 0.5 U/mL heparin) | Argatroban (13 d), danaparoid (19 d), apixaban at discharge | Platelet recovery, discharge from hospital | Alive |
| 1837 | 63, M | ICU (RRT) | RRT | LMWH and UFH; NA | N/A | N/A | 67 | PE | ≥4 | ELISA IgG (OD 0.62) | SRA, positive | Argatroban | N/A | Death |
| 1938 | 65, F | Non-ICU | AF | LMWH and UFH; therapeutic | 12 | 290 | 63 | Stroke, PE, iliac and femoral artery thrombosis, | 6 | CIA (9.7 U/mL) | SRA, positive (94%) | Argatroban, apixaban | Platelet recovery, discharge from hospital | Alive |
| 2039 | 65, M | Non-ICU | N/A | N/A | N/A (8 d after diagnosis of COVID-19) | N/A | 6 | DVT, PE (at presentation) | N/A | NR, positive | SRA, positive | Argatroban, apixaban, IVIG | Platele recovery, discharge from hospital | Alive |
ARDS, acute respiratory distress syndrome; CIA, chemiluminescent immunoassay (cutoff < 1 U/mL); DVT, deep vein thrombosis; ECMO, extracorporeal membrane oxygenation; ELISA, enzyme-link immunosorbent assay; F, female; HIPLA, heparin-induced platelet activation assay (positivity threshold 13%); ICU, intensive care unit; LITA, latex immune turbidimetric assay; M, male; MV, mechanical ventilation; N/A, not available; PE, pulmonary embolism; RRT, renal replacement therapy; TE, thromboembolism; VTE, venous thromboembolism.
COAG-COVID (Coagulopathy of COVID-19: A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care).