Thrombotic microangiopathy: COVID-19 or hydroxychloroquine?

Hasbal, Nuri Barış

doi:10.1016/j.kint.2020.08.030

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…The TMA was attributed to Covid-19 infection by the authors, this was subsequently challenged in a letter to the editor correlating the temporal profile of TMA in this particular patient with hydroxychloroquine therapy. However, the authors refuted this query by a counter explanation ratiocinating a delayed two-week onset of TMA after stopping hydroxychloroquine thereby ruling out the cause and effect relation ( Jhaveri et al, 2020 ; Hasbal, 2020 ; Wanchoo et al, 2018 ). Agreed that TMA could have been due to a genetic variant of TMA (a HUS) and the virus could have acted as a second hit in unmasking the TMA or even made a direct contribution via a novel mechanism and HCQ may or may not have contributed to the development of TMA in that particular patient howbeit, a long elimination half-life of 40 days after a single dose of 200 mg HCQ, questions the explanation given by the authors in acquitting HCQ as a cause of TMA in that particular patient and hence raises some eyebrows ( Tett et al, 1989 ).…”

mentioning

confidence: 99%

Thrombotic microangiopathy (aHUS/iTTP) reported so far in Covid-19 patients: The virus alone or an omnium gatherum of mechanisms and etiologies?

Mir¹

2021

Critical Reviews in Oncology/Hematology

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confidence: 99%

Thrombotic microangiopathy (aHUS/iTTP) reported so far in Covid-19 patients: The virus alone or an omnium gatherum of mechanisms and etiologies?

Mir¹

2021

Critical Reviews in Oncology/Hematology

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“…However, it is questionable whether COVID-19 acts as the sole cause of these reported TMAs, as other possible TMA-causing factors were also present in the majority of cases published to date. For example, in a subset of the reported cases, concomitant hydroxychloroquine use could cause drug-induced TMA [ 22 , 23 ], which has been pointed out by other colleagues [ 24 ]. A unique case of coexistence of SARS-CoV-2 infection, hydroxychloroquine intake and pregnancy, where all three conditions could contribute to the development of TMA, has also been reported [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

Vrecko¹,

Večerić-Haler²

2022

J Hematol

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Coronavirus disease 2019 (COVID-19) has spread tremendously since its first appearance in December 2019. Infected individuals can experience a wide range of systemic complications, including thrombotic microangiopathy (TMA). Like the other forms of TMA, COVID-19-associated TMA is characterized by thrombocytopenia, hemolytic anemia, and organ failure (such as acute kidney injury). The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in COVID-19-associated TMA is most probably dual: it can act either as a trigger to an underlying condition or as a cause of TMA. As opposed to the majority of other reported cases, it may be that in our case COVID-19 was the only cause of TMA. We present a case of a 32-year-old previously healthy man who was treated for acute kidney injury associated with TMA, which we believe was caused by COVID-19. Thrombotic thrombocytopenic purpura, as well as other possible known causes of typical and atypical hemolytic-uremic syndrome, was excluded. During his hospitalization, three negative nasopharyngeal swabs for SARS-CoV-2 were obtained, but serological tests showed the presence of IgG and IgA antibodies. After initial treatment known to be helpful in other forms of TMA (therapeutic plasma exchange and methylprednisolone), his renal function and platelet count recovered completely. Our case illustrates the importance of quickly recognizing this life-threatening complication of COVID-19 and using treatment that has been shown to be beneficial in other forms of TMA. Future studies of the pathophysiology and subsequent targeted treatment of this novel disease are needed.

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“…Male gender, advanced age, obesity, critically ill ICU patients with severe COVID-19 infection, immobility, thrombogenic drugs (hormone replacement therapy, intravenous immune globulin, sildenafil, corticosteroids, erythropoietin, etc.) are associated with increased risk of VTE [ 36 , 37 ]. The previous history of VTE, cancer, sepsis, pregnancy, stroke, trauma, or surgery also can pose an additional risk for thrombosis [ 32 ].…”

Section: Risk Factors Associated With Vte In Covid-19mentioning

confidence: 99%

Approach to Thromboprophylaxis for Prevention of Venous Thromboembolism in COVID-19: Global Updates and Clinical Insights from India

Ramakrishnan

Ramasubban

Hegde

et al. 2022

Clinics and Practice

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Venous thromboembolism (VTE) frequently occurs in patients with coronavirus disease-19 (COVID-19) and is associated with increased mortality. Several global guidelines recommended prophylactic-intensity anticoagulation rather than intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute or critical illness without suspected or confirmed VTE. Even though standard doses of thromboprophylaxis are received, many cases of thrombotic complications are reported; hence, appropriate and adequate thromboprophylaxis is critical for the prevention of VTE in COVID-19. In spite of an increased prevalence of VTE in Indian patients, sufficient data on patient characteristics, diagnosis, and therapeutic approach for VTE in COVID is lacking. In this article, we review the available global literature (search conducted up to 31 May 2021) and provide clinical insights into our approach towards managing VTE in patients with COVID-19. Furthermore, in this review, we summarize the incidence and risk factors for VTE with emphasis on the thromboprophylaxis approach in hospitalized patients and special populations with COVID-19 and assess clinical implications in the Indian context.

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Thrombotic microangiopathy: COVID-19 or hydroxychloroquine?

Cited by 7 publications

References 4 publications

Thrombotic microangiopathy (aHUS/iTTP) reported so far in Covid-19 patients: The virus alone or an omnium gatherum of mechanisms and etiologies?

Thrombotic microangiopathy (aHUS/iTTP) reported so far in Covid-19 patients: The virus alone or an omnium gatherum of mechanisms and etiologies?

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

Approach to Thromboprophylaxis for Prevention of Venous Thromboembolism in COVID-19: Global Updates and Clinical Insights from India

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