Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia

The SARS-CoV-2 (COVID-19) is causing a pandemic and potentially fatal disease of global public health concern. Viral infections are known to be associated with coagulation impairment; thus, thrombosis, hemorrhage, or both may occur. Understanding the pathophysiologic mechanisms underlying the develo...

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Bibliographic Details
Published in:Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2020-09, Vol.8 (5), p.711-716
Main Authors: Costanzo, Luca, Palumbo, Francesco Paolo, Ardita, Giorgio, Antignani, Pier Luigi, Arosio, Enrico, Failla, Giacomo
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
Betacoronavirus
Blood Coagulation Disorders - drug therapy
Blood Coagulation Disorders - virology
Coagulopathy
Coronavirus Infections - complications
Coronavirus Infections - drug therapy
Coronavirus Infections - physiopathology
COVID-19
D-dimer
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Low-molecular-weight heparin
Pandemics
Pneumonia
Pneumonia, Viral - complications
Pneumonia, Viral - drug therapy
Pneumonia, Viral - physiopathology
SARS-CoV-2
Thrombosis
Thrombosis - drug therapy
Thrombosis - virology
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Summary:The SARS-CoV-2 (COVID-19) is causing a pandemic and potentially fatal disease of global public health concern. Viral infections are known to be associated with coagulation impairment; thus, thrombosis, hemorrhage, or both may occur. Understanding the pathophysiologic mechanisms underlying the development of coagulation disorders during viral infection is essential for the development of therapeutic strategies. Coagulopathy in COVID-19 infection is emerging as a precipitant factor for severe respiratory complications and death. An increase in coagulation markers, such as fibrinogen and D-dimer, has been found in severe COVID-19 cases. Heparin, clinically used as an anticoagulant, also has anti-inflammatory properties, including binding of inflammatory cytokines, inhibition of neutrophil chemotaxis, and protection of endothelial cells, and a potential antiviral effect. We hypothesized that low-molecular-weight heparin may attenuate cytokine storm in COVID-19 patients; therefore, low-molecular-weight heparin could be a valid adjunctive therapeutic drug for the treatment of COVID-19 pneumopathy. In this paper, we review potential mechanisms involved in coagulation impairment after viral infection and the possible role of heparin in the treatment of COVID-19 patients.
ISSN:2213-333X
2213-3348
DOI:10.1016/j.jvsv.2020.05.018