PMC:7388103 / 4585-6498 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7388103","sourcedb":"PMC","sourceid":"7388103","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7388103","text":"Other Patients With COVID and Possible HIT\nWe encountered 4 additional patients admitted to our ICU with a diagnosis of acute respiratory distress syndrome secondary to COVID-19 infection with thrombocytopenia, and an intermediate to high pretest probability for HIT. Due to a positive platelet factor 4 (PF4) antibody, they were started on an argatroban, pending send out results of OD levels and functional assay. However, the SRA was negative. Interestingly, their clinical characteristics (reported in Table 1) were similar to those of our patients with true HIT. Two of these patients had a confirmed deep vein thrombosis, and one with suspected pulmonary embolism. Also, 2 patients met International Society on Thrombosis and Haemostasis criteria for disseminated intravascular coagulation (DIC). All the patients were in hypotensive shock, requiring vasopressor support.\nTable 1. Characteristics of Patients Who Tested Positive for PF4 Antibody.\nCharacteristics Patient 1a Patient 2 Patient 3 Patient 4 Patient 5\nAge in years 63 53 63 70 46\nSex Male Male Male Female Female\nIndication for anticoagulation DVT Acute coronary syndrome and atrial fibrillation DVT DVT Suspected PE\nConfirmed thrombosis via imaging Yes No Yes Yes No\nDays from initiation of heparin to drop in platelets 11 7 6 8 2\n4T score 6 5 7 7 4\nPF4 antibody (optical density) Positive (1.243) Positive (0.707) Positive (0.767) Positive (0.042) Positive (0.307)\nSerotonin release assay Positive Negative Negative Negative Negative\nPresence of DIC by ISTH criteria No No No Yes Yes\nAbbreviations: DVT, deep vein thrombosis; PE, pulmonary embolism; PF4, platelet factor 4; DIC, disseminated intravascular coagulation; ISTH, International Society on Thrombosis and Haemostasis; HIT, heparin-induced thrombocytopenia.\na Patient 1 had true HIT. Patients 2 to 5 had false-positive HIT 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