Thrombocytopenia in COVID-19 patients: The role of fondaparinux and succinates in improving outcomes (exchange of experience)

As is known, the new coronavirus infection (NCI) COVID-19 is accompanied by coagulopathy, for the treatment of which heparins are widely used that can cause heparin-induced thrombocytopenia type 2 (HIT), complicated by paradoxical thrombosis. A considerable number of cases of sudden thrombosis after vaccination with Pfizer, Moderna, and Oxford–AstraZeneca vaccines was also described, caused by vaccine-induced “spontaneous HIT syndrome”. An analysis of the medical histories of hospitalized COVID-19 patients (a total of 3,455), showed an 8-fold increase in the frequency of severe thrombocytopenia (<100 × 109/l), compared with patients of the pre-Covid period, and approximately 25% of them can be attributed to the manifestation of HIT. The use of the original Rule of express HIT-diagnostics in the pre-Covid period (“100–5–100”) and the original Algorithm for HIT-treatment (includes the transition to the use of Fondaparinux and succinate-containing drugs), as shown by an earlier our study, made it possible to reduce the frequency of severe thrombotic complications and significantly improve the results of treatment in non-infectious patients. These Rule and Algorithm have been applied in patients with NCI since 2021. The use of these principles partly explains the 3-times decrease of in-hospital mortality in 2021, compared with 2020 (from 18.0% to 6.7%), that coincides with an increase in the use of Fondaparinux and succinate-containing preparations in hospital. Thus, the application of the described Rule and Algorithm in the treatment of patients with NCI COVID-19 increases the effectiveness of treatment and reduces hospital mortality.

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