Heparin-induced thrombocytopenia in COVID-19 patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation: two case reports.

Abstract

Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is increasingly used in Coronavirus disease-19 (COVID-19) patients with the most severe forms of acute respiratory distress syndrome (ARDS). Its use is associated with a significant hemostatic challenge, especially in COVID- 19 patients who have been demonstrated to otherwise present a COVID-19-associated coagulopathy. The systematic use of unfractionated heparin therapy to prevent circuit thrombosis is warranted during ECMO support. The clinical presentation and management of heparin-induced thrombocytopenia, which is a rare but life-threatening complication of heparin therapy, has not been described in those patients yet. We report herein two cases of laboratory-confirmed HIT in COVID-19 patients with severe ARDS admitted to our intensive care unit for VV-ECMO support and the successful use of argatroban as an alternative therapy. We also provide a brief literature review of best evidence for managing such patients. The diagnosis and management of HIT is particularly challenging in COVID-19 patients receiving ECMO support. An increased awareness is warranted in those patients who already present a procoagulant state leading to higher rates of thrombotic events which can confuse the issues. Argatroban seems to be an appropriate and safe therapeutic option in COVID-19 patients with HIT while on VV-ECMO.

• Authors: Frank Bidar, Guillaume Hékimian, Isabelle Martin-Toutain, Guillaume Lebreton, Alain Combes, Corinne Frère
• Journal: Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs (J Artif Organs) Vol. 24 Issue 2 Pg. 277-281 (Jun 2021) ISSN: 1619-0904 [Electronic] Japan
• PMID: 32789604 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Heparin

Topics

• Adult
• Anticoagulants (adverse effects)
• COVID-19 (therapy)
• Extracorporeal Membrane Oxygenation
• Female
• Heparin (adverse effects)
• Humans
• Intensive Care Units
• Male
• Middle Aged
• Respiratory Distress Syndrome (therapy)
• Thrombocytopenia (chemically induced, therapy)