A journey through anticoagulant therapies in the treatment of left ventricular thrombus in post-COVID-19 heparin-induced thrombocytopenia: a case report

Lazaro-Garcia, Alberto; Martínez-Alfonzo, Inés; Vidal-Laso, Rosa; Velasco-Rodríguez, Diego; Tomás-Mallebrera, Marta; Gonzalez-Rodriguez, Marta; Llamas-Sillero, Pilar

doi:10.1080/16078454.2022.2043572

Cited by 5 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 43 patients from 40 studies were included in this analysis after full-text screening, involving 39 case reports ( Plassat et al, 2002 ; Betrosian et al, 2003 ; Franke et al, 2003 ; Ng and Lee, 2003 ; Zamir et al, 2003 ; Dager and White, 2004 ; Patel and Knight, 2005 ; Doboszyńska et al, 2007 ; Rota et al, 2008 ; Famularo et al, 2009 ; Mumoli and Cei, 2010 ; Fesler et al, 2011 ; Illes et al, 2011 ; Iturbe et al, 2011 ; Yazbek et al, 2012 ; Klinkert et al, 2013 ; Leporini et al, 2013 ; Nazliel et al, 2014 ; Sinan et al, 2014 ; Brouns and Jie, 2015 ; Giuliani et al, 2015 ; Hantson et al, 2015 ; Koufakis et al, 2015 ; Larsen et al, 2015 ; Martinez and Burnett, 2015 ; Sartori et al, 2015 ; Wiegele et al, 2015 ; Pérez et al, 2016 ; Gan, 2017 ; Rivera et al, 2017 ; Le et al, 2019 ; Barcellona et al, 2020 ; Polák et al, 2020 ; Singh et al, 2020 ; Lovatt and Crowther, 2021 ; Tucker and Padarti, 2021 ; Byrne et al, 2022 ; Lázaro-García et al, 2022 ; Malinauskiene et al, 2022 ) and one case series ( Hartman et al, 2006 ) ( Figure 1 ). Patients’ information is summarized in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database

Liu,

Zheng,

Chen

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are commonly used anticoagulants for the management of arterial and venous thromboses. However, it is crucial to be aware that LMWH can, in rare cases, lead to a dangerous complication known as heparin-induced thrombocytopenia (HIT). The objective of this study was to evaluate the pharmacovigilance and clinical features of HIT associated with LMWH, as well as identify treatment strategies and risk factors to facilitate prompt management.Methods: We extracted adverse event report data from the FDA Adverse Event Reporting System (FAERS) database for pharmacovigilance assessment. Case reports on LMWH-induced thrombocytopenia dated up to 20 March 2023 were collected for retrospective analysis.Results: Significantly elevated reporting rates of HIT were shown in adverse event (AE) data of LMWHs in the FAERS database, while tinzaparin had a higher proportional reporting ratio (PRR) and reporting odds ratio (ROR) than other LMWHs, indicating a greater likelihood of HIT. Case report analysis indicated that a total of 43 patients showed evidence of LMWH-induced thrombocytopenia with a median onset time of 8 days. Almost half of the events were caused by enoxaparin. LMWHs were mainly prescribed for the treatment of embolism and thromboprophylaxis of joint operation. Patients with a history of diabetes or surgery appeared to be more susceptible to HIT. Clinical symptoms were mostly presented as thrombus, skin lesion, and dyspnea. Almost 90% of the patients experienced a platelet reduction of more than 50% and had a Warkentin 4T score of more than 6, indicating a high likelihood of HIT. In all patients, LMWHs that were determined to be the cause were promptly withdrawn. Following the discontinuation of LMWHs, almost all patients were given alternative anticoagulants and eventually achieved recovery.Conclusion: LMWH-induced thrombocytopenia is rare but serious, with increased risk in patients with diabetes or a surgical history. Prompt recognition and management are crucial for the safe use of LMWHs.

show abstract

Section: Resultsmentioning

confidence: 99%

Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database

Liu,

Zheng,

Chen

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…In another patient, an in-transit thrombus extending into the LV outflow tract and protruding through the aortic valve was identified [ 102 ]. A catastrophic clinical presentation was seen in a 57-year-old patient who developed heparin-induced thrombocytopenia associated with recurrent LV thrombosis, arterial thrombi in both lower limbs, and STEMI [ 103 ].…”

Section: The Use Of Doacs In Patients With LV Thrombusmentioning

confidence: 99%

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

Bădescu

Șorodoc

Lionte

et al. 2023

JPM

View full text Add to dashboard Cite

In recent years, direct oral anticoagulants (DOAC) have accumulated evidence of efficacy and safety in various clinical scenarios and are approved for a wide spectrum of indications. Still, they are currently used off-label for left ventricular thrombus owing to a paucity of evidence. For the same reason, there is a lack of guideline indication as well. Our work is based on an exhaustive analysis of the available literature and provides a structured and detailed update on the use of DOACs in patients with left ventricle thrombus. The safety and efficacy of DOACs were analyzed in particular clinical scenarios. As far as we know, this is the first paper that analyzes DOACs in this approach.

show abstract

“…These latter agents may be especially attractive since their activity directly inhibits thrombin and does not require antithrombin as a cofactor to achieve anticoagulation, and has a faster onset of action than UFH (13). They have been especially advocated in patients where heparin is no longer effective or needs to be terminated by the occurrence of heparin induced thrombocytopenia (HIT) (14).…”

mentioning

confidence: 99%

Anticoagulant Use During Extracorporeal Membrane Oxygenation Using Heparin and Direct Thrombin Inhibitors in COVID-19 and ARDS Patients

Stammers¹,

Tesdahl²,

Barletti³

et al. 2022

J Extra Corpor Technol

View full text Add to dashboard Cite

Coagulopathies develop in patients supported with the use of extracorporeal membrane oxygenation (ECMO) and can be hemorrhagic and/or thrombophilic in spite of the use of systemic anticoagulation. The purpose this study was to examine the use of heparin and direct thrombin inhibitors (DTI) in COVID-19 patients with acute respiratory distress syndrome (ARDS) on ECMO, with a subset analysis by disease state. Following IRB approval, 570 consecutive records were reviewed of adult patients on venovenous ECMO between May 2020 and December 2021. Patients were grouped by anticoagulant use: Heparin Only (n = 373), DTI Only (bivalirudin or argatroban, n = 90), or DTI after Heparin (n = 107). The effect of anticoagulant grouping was assessed using Bayesian mixed-effects logistic regression adjusting for age, body mass index (BMI), gender, days of mechanical ventilation prior to ECMO, indication for ECMO support, hepatic and renal failure, hours on ECMO, hours off anticoagulation, coagulation monitoring target, and hospital. The primary endpoint was circuit failure requiring change-out with secondary endpoints of organ failure and mortality. Regression-adjusted probability of circuit change-outs were as follows: DTI after Heparin patients—32.7%, 95% Credible Interval [16.1–51.9%]; DTI Only patients—23.3% [7.5–40.8%]; and Heparin Only patients—19.8% [8.1–31.3%]. The posterior probability of difference between groups was strongest for DTI after Heparin vs. Heparin Only (97.0%), moderate for DTI after Heparin vs. DTI Only (88.2%), and weak for DTI Only vs. Heparin only (66.6%). The occurrence of both hepatic and renal failure for DTI Only and DTI after Heparin patients was higher than that of Heparin Only patients. Unadjusted mortality was highest for DTI after Heparin (64.5%) followed by DTI Only (56.7%), and Heparin Only (50.1%, p = 0.027). DTI after Heparin was associated with an increased likelihood of circuit change-out. Unadjusted hepatic failure, renal failure, and mortality were more frequent among DTI patients than Heparin Only patients.

show abstract

A journey through anticoagulant therapies in the treatment of left ventricular thrombus in post-COVID-19 heparin-induced thrombocytopenia: a case report

Cited by 5 publications

References 16 publications

Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database

Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

Anticoagulant Use During Extracorporeal Membrane Oxygenation Using Heparin and Direct Thrombin Inhibitors in COVID-19 and ARDS Patients

Contact Info

Product

Resources

About