Thrombosis and Haemostasis challenges in COVID-19 – Therapeutic perspectives of heparin and tissue-type plasminogen activator and potential toxicological reactions-a mini review

• Published in: Food and chemical toxicology 2021-02, Vol.148, p.111974-111974, Article 111974
• Main Authors: Mazilu, Laura, Katsiki, Niki, Nikolouzakis, Taxiarchis Konstantinos, Aslanidis, Minas I., Lazopoulos, George, Kouretas, Dimitrios, Tsatsakis, Aristidis, Suceveanu, Andra-Iulia, Stoian, Anca-Pantea, Parepa, Irinel-Raluca, Voinea, Felix, Suceveanu, Adrian Paul, Arsene, Andreea Letiția, Velescu, Bruno Ștefan, Vesa, Cosmin, Nitipir, Cornelia
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Anticoagulant; COVID-19; COVID-19 - physiopathology; Hemostasis - drug effects; Heparin; Heparin - pharmacology; Heparin - therapeutic use; Humans; Review; Thrombosis - complications; Tissue Plasminogen Activator - pharmacology; Tissue Plasminogen Activator - therapeutic use; Tissue-type plasminogen activator; Toxicological side effects
• ISSN: 0278-6915; 1873-6351
• DOI: 10.1016/j.fct.2021.111974

The coronavirus disease (COVID)-19 pandemic is a major challenge for the health systems worldwide. Acute respiratory distress syndrome (ARDS), is one of the most common complications of the COVID-19 infection. The activation of the coagulation system plays an important role in the pathogenesis of ARDS. The development of lung coagulopathy involves thrombin generation and fibrinolysis inhibition. Unfractionated heparin and its recently introduced counterpart low molecular weight heparin (LMWH), are widely used anticoagulants with a variety of clinical indications allowing for limited and manageable physio-toxicologic side effects while the use of protamine sulfate, heparin's effective antidote, has made their use even safer. Tissue-type plasminogen activator (tPA) is approved as intravenous thrombolytic treatment. The present narrative review discusses the use of heparin and tPA in the treatment of COVID-19-induced ARDS and their related potential physio-toxicologic side effects. The article is a quick review of articles on anticoagulation in COVID infection and the potential toxicologic reactions associated with these drugs. •Anticoagulant therapy is essential in decreasing fibrin deposition and microthrombus formation in the ARDS and in the treatment of pro-thrombotic complications.•Administration of tPA in ARDS patients could provide anti-inflammatory effects.•Heparin and tPA may be useful in these patients minimizing the risk for ARDS complications and/or reducing the pressure on the ventilator support in the Intensive Care Unit