Prevalence and clinical implication of thrombocytopenia and heparin-induced thrombocytopenia in patients who are critically ill with COVID-19

Reut Kassif Lerner; Dor Lotan; Daniel Oren; Edward Itelman; Yuval Neeman; Shahar Dekel; Eyal Heller; Arsalan Abu-Much; Noya Shilo; Rami Gilead; Evyatar Hubara; Meir Mouallem; Yael Haviv; Alexander Kogan; Haim Mayan; Itai M Pessach

doi:10.7861/clinmed.2022-0054

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Fig 1.
Admission, peak and nadir platelet counts in non-thrombocytopenic and thrombocytopenic groups.

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Table 1.

Demographics and clinical features of patients who were critically ill with COVID-19 with and without thrombocytopenia

	Non-thrombocytopenic cohort, n=50	Thrombocytopenic cohort, n=57	p-value
Age, years, median (IQR)	67.50 (53.50–73.00)	61.00 (54.00–68.00)	0.158
Women, n (%)	14 (28.6)	6 (10.5)	0.034
BMI, kg/m ², median (IQR)	29.40 (26.25–33.62)	27.90 (24.80–30.00)	0.113
Diabetes, n (%)	22 (44.0)	19 (33.3)	0.351
IHD, n (%)	10 (20.0)	8 (14.0)	0.573
Malignancy, n (%)	4 (8.0)	4 (7.0)	1.000
Haematological disorder, n (%)	3 (6.0)	4 (7.0)	1.000
Hypertension, n (%)	22 (44.0)	27 (47.4)	0.877
Dyslipidaemia, n (%)	27 (54.0)	21 (36.8)	0.113
COPD/CLD, n (%)	6 (12.0)	4 (7.0)	0.582
CRF, n (%)	3 (6.0)	9 (15.8)	0.196
Thyroid disease, n (%)	9 (18.0)	3 (5.3)	0.076

BMI = body mass index; COPD = chronic obstructive pulmonary disease; CLD = chronic lung disease; CRF = chronic renal failure; IHD = ischaemic heart disease; IQR = interquartile range.

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Table 2.

Hospitalisation course and outcomes of patients who were critically ill with COVID-19 with and without thrombocytopenia and with and without disseminated intravascular coagulation

	Non-thrombocytopenic cohort, n=50	Thrombocytopenic cohort, n=57	p-value	No DIC, n=91	DIC, n=16	p-value
Mechanical ventilation, n (%)	35 (70.0)	50 (87.7)	0.043	69 (75.8)	16 (100.0)	0.061
Blood products, n (%)	21 (42.0)	41 (71.9)	0.003	47 (51.6)	15 (93.8)	0.004
PLT, n (%)	0 (0.0)	13 (22.8)	0.001	6 (6.6)	7 (43.8)	<0.001
FFP, n (%)	2 (4.0)	13 (22.8)	0.012	8 (8.8)	7 (43.8)	0.001
Cryo, n (%)	0 (0.0)	7 (12.3)	0.030	1 (1.1)	6 (37.5)	<0.001
ECS, n (%)	6 (12.0)	33 (57.9)	<0.001	26 (28.6)	13 (81.2)	<0.001
Bleeding, n (%)	19 (38.0)	29 (50.9)	0.254	36 (39.6)	12 (75.0)	0.018
Thrombosis, n (%)	4 (8.0)	8 (14.0)	0.496	10 (11.0)	2 (12.5)	1.000
LOS, days, median (IQR)	18.00 (7.5–39.5)	33.00 (12.25–40.75)	0.050	22 (12.00–38.00)	34 (18.75–39.50)	0.317
Mortality, n (%)	16 (32.0)	32 (56.1)	0.021	39 (42.9)	9 (56.2)	0.471

Cryo = cryoprecipitates; DIC = disseminated intravascular coagulation; ECS = extracorporeal support; FFP = fresh frozen plasma; IQR = interquartile range; LOS = length of stay (survivors); PLT = platelets.

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Table 3.

Peak values during hospitalisation for patients who were critically ill with COVID-19 with and without thrombocytopenia

	Non-thrombocytopenic group, n=50, median (IQR)	Thrombocytopenic group, n=57, median (IQR)	p-value
Triglycerides, mg/dL	180 (113–369)	310 (169–480)	0.042
LDL, mg/dL	99.0 (69.5–144)	129 (78.0–168)	0.154
Creatinine, mg/dL	1.06 (0.90–2.11)	1.81 (1.00–3.45)	0.024
Fibrinogen, mg/dL	824 (723–913)	747 (541–886)	0.021
CRP, mg/L	307 (233–398)	317 (228–357)	0.888
D-dimer, ng/mL	5,880 (2,061–16,004)	20,350 (6,490–32,278)	0.001
INR	1.37 (1.24–1.48)	1.50 (1.35–1.70)	0.007

CRP = C-reactive protein; INR = international normalised ratio; IQR = interquartile range; LDL = low-density lipoprotein; LDH = lactate dehydrogenase.

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Table 4.

Clinical course and outcomes of patients who were critically ill with COVID-19 with and without heparin-induced thrombocytopenia

	No HIT, n=91	HIT, n=16	p-value
Mechanically ventilated, n (%)	69 (75.8)	16 (100.0)	0.061
Thrombosis, n (%)	9 (9.9)	3 (18.8)	0.544
Bleeding, n (%)	36 (39.6)	12 (75.0)	0.018
Blood products, n (%)	46 (50.5)	16 (100.0)	0.001
PLT, n (%)	4 (4.4)	9 (56.2)	<0.001
FFP, n (%)	10 (11.0)	5 (31.2)	0.078
Cryo, n (%)	4 (4.4)	3 (18.8)	0.111
ECS, n (%)	23 (25.3)	16 (100.0)	<0.001
ECMO, n (%)	8 (8.8)	14 (87.5)	<0.001
CVVH, n (%)	22 (24.2)	9 (56.2)	0.021
Dialysis, n (%)	6 (6.6)	4 (25.0)	0.062
LOS, days, median (IQR)	21.00 (12.00–37.50)	31.50 (21.25–53.25)	0.026
Mortality, n (%)	37 (40.7)	11 (68.8)	0.070

Cryo = cryoprecipitate; CVVH = continuous venous-venous hemofiltration; DIC = disseminated intravascular coagulopathy; ECMO = extracorporeal membrane oxygenation; ECS = extracorporeal support; FFP = fresh frozen plasma; HIT = heparin-induced thrombocytopenia; IQR = interquartile range; LOS = length of stay; PLT = platelets.