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Talasaz AH, Sadeghipour P, Kakavand H, Aghakouchakzadeh M, Kordzadeh-Kermani E, Van Tassell BW, Gheymati A, Ariannejad H, Hosseini SH, Jamalkhani S, Sholzberg M, Monreal M, Jimenez D, Piazza G, Parikh SA, Kirtane AJ, Eikelboom JW, Connors JM, Hunt BJ, Konstantinides SV, Cushman M, Weitz JI, Stone GW, Krumholz HM, Lip GYH, Goldhaber SZ, Bikdeli B. Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:1903-1921. [PMID: 33741176 PMCID: PMC7963001 DOI: 10.1016/j.jacc.2021.02.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.
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Affiliation(s)
- Azita H Talasaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. https://twitter.com/AzitaTalasaz
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hessam Kakavand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aghakouchakzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Kordzadeh-Kermani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA; Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Azin Gheymati
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ariannejad
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Hosseini
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Jamalkhani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Michelle Sholzberg
- Departments of Medicine and Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trials i Pujol, Universidad Católica San Antonio de Murcia, Barcelona, Spain
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sahil A Parikh
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jean M Connors
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Beverley J Hunt
- Haemostasis and Thrombosis Centre, St. Thomas' Hospital, London, United Kingdom
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University of Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Komotini, Greece
| | - Mary Cushman
- Department of Medicine, University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, Vermont, USA; Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, Vermont, USA
| | - Jeffrey I Weitz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA.
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102
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Longchamp G, Manzocchi-Besson S, Longchamp A, Righini M, Robert-Ebadi H, Blondon M. Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis. Thromb J 2021; 19:15. [PMID: 33750409 PMCID: PMC7942819 DOI: 10.1186/s12959-021-00266-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND COVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODS This meta-analysis included original articles in English published from January 1st, 2020 to June 15th, 2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTS In 33 studies (n = 4009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2 = 92.5) overall, and 21% (95%CI 14-28%, I2 = 87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2 = 87.0%) and 8% (95%CI 3-14%, I2 = 87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2 = 92.1%) and 17% (95%CI 11-25%, I2 = 89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%). CONCLUSIONS The risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATION The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews ( CRD42020193369 ).
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Affiliation(s)
- Gregoire Longchamp
- Department of Visceral Surgery, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
| | - Sara Manzocchi-Besson
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Department of Vascular Surgery, Centre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion), Sion, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Marc Righini
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marc Blondon
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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103
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Chan ED, Majluf-Cruz A. Is the Angioedema Associated with COVID-19 a Real Entity, a Mimic, or Both? Am J Respir Crit Care Med 2021; 203:645-646. [PMID: 33357169 PMCID: PMC7924563 DOI: 10.1164/rccm.202011-4141le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Edward D Chan
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora, Colorado.,National Jewish Health Denver Colorado.,University of Colorado Anschutz Medical Campus Aurora, Colorado and
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104
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Siegel A, Al Rubaiay A, Adelsheimer A, Haight J, Gawlik S, Oropallo A. Pedal gangrene in a patient with COVID-19 treated with prone positioning and extracorporeal membrane oxygenation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:357-360. [PMID: 33688601 PMCID: PMC7931670 DOI: 10.1016/j.jvscit.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/23/2021] [Indexed: 10/26/2022]
Abstract
Many patients hospitalized with coronavirus disease 2019 are treated with venovenous extracorporeal membrane oxygenation and prone positioning to optimize oxygenation. However, this combination can result in lower extremity tissue necrosis, especially without adequate offloading. We report the case of a 31-year-old man who required mechanical ventilation and venovenous extracorporeal membrane oxygenation secondary to complications from coronavirus disease 2019, and subsequently developed pedal dry gangrene. The patient was discharged and healed without requiring an amputation. Our institution has since revised the prone positioning protocol to address offloading the lower extremities and feet.
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Affiliation(s)
- Amanda Siegel
- Department of Podiatry, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY
| | - Ammar Al Rubaiay
- Department of Podiatry, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY
| | - Andrew Adelsheimer
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY
| | - John Haight
- Department of Podiatry, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY
| | - Scott Gawlik
- Department of Podiatry, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY
| | - Alisha Oropallo
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY.,Department of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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105
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Habashi NM, Camporota L, Gatto LA, Nieman G. Functional pathophysiology of SARS-CoV-2-induced acute lung injury and clinical implications. J Appl Physiol (1985) 2021; 130:877-891. [PMID: 33444117 PMCID: PMC7984238 DOI: 10.1152/japplphysiol.00742.2020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
The worldwide pandemic caused by the SARS-CoV-2 virus has resulted in over 84,407,000 cases, with over 1,800,000 deaths when this paper was submitted, with comorbidities such as gender, race, age, body mass, diabetes, and hypertension greatly exacerbating mortality. This review will analyze the rapidly increasing knowledge of COVID-19-induced lung pathophysiology. Although controversial, the acute respiratory distress syndrome (ARDS) associated with COVID-19 (CARDS) seems to present as two distinct phenotypes: type L and type H. The "L" refers to low elastance, ventilation/perfusion ratio, lung weight, and recruitability, and the "H" refers to high pulmonary elastance, shunt, edema, and recruitability. However, the LUNG-SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) and ESICM (European Society of Intensive Care Medicine) Trials Groups have shown that ∼13% of the mechanically ventilated non-COVID-19 ARDS patients have the type-L phenotype. Other studies have shown that CARDS and ARDS respiratory mechanics overlap and that standard ventilation strategies apply to these patients. The mechanisms causing alterations in pulmonary perfusion could be caused by some combination of 1) renin-angiotensin system dysregulation, 2) thrombosis caused by loss of endothelial barrier, 3) endothelial dysfunction causing loss of hypoxic pulmonary vasoconstriction perfusion control, and 4) hyperperfusion of collapsed lung tissue that has been directly measured and supported by a computational model. A flowchart has been constructed highlighting the need for personalized and adaptive ventilation strategies, such as the time-controlled adaptive ventilation method, to set and adjust the airway pressure release ventilation mode, which recently was shown to be effective at improving oxygenation and reducing inspiratory fraction of oxygen, vasopressors, and sedation in patients with COVID-19.
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Affiliation(s)
- Nader M Habashi
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Louis A Gatto
- Department of Surgery, Upstate Medical University, Syracuse, New York
| | - Gary Nieman
- Department of Surgery, Upstate Medical University, Syracuse, New York
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106
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Chitrakar B, Zhang M, Bhandari B. Improvement strategies of food supply chain through novel food processing technologies during COVID-19 pandemic. Food Control 2021; 125:108010. [PMID: 33679006 PMCID: PMC7914018 DOI: 10.1016/j.foodcont.2021.108010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-19 (COVID-19) is a contagious disease caused by a novel corona virus (SARS-CoV-2). No medical intervention has yet succeeded, though vaccine success is expected soon. However, it may take months or years to reach the vaccine to the whole population of the world. Therefore, the technological preparedness is worth to discuss for the smooth running of food processing activities. We have explained the impact of the COVID-19 pandemic on the food supply chain (FSC) and then discussed the technological interventions to overcome these impacts. The novel and smart technologies during food processing to minimize human-to-human and human-to-food contact were compiled. The potential virus-decontamination technologies were also discussed. Finally, we concluded that these technologies would make food processing activities smarter, which would ultimately help to run the FSC smoothly during COVID-19 pandemic.
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Affiliation(s)
- Bimal Chitrakar
- State Key Laboratory of Food Science and Technology, Jiangnan University, 214122, Wuxi, Jiangsu, China
| | - Min Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, 214122, Wuxi, Jiangsu, China.,International Joint Laboratory on Food Safety, Jiangnan University, 214122, Wuxi, Jiangsu, China
| | - Bhesh Bhandari
- School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
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107
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Industry Update covering November 2020. Ther Deliv 2021; 12:183-189. [PMID: 33624539 DOI: 10.4155/tde-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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108
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Hunt BJ, De Paula EV, McLintock C, Dumantepe M. Prophylactic anticoagulation for patients in hospital with covid-19. BMJ 2021; 372:n487. [PMID: 33608304 DOI: 10.1136/bmj.n487] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Beverley J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Erich V De Paula
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Claire McLintock
- Maternal-Fetal Medicine Service, National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Mert Dumantepe
- Department of Cardiovascular Surgery, School of Medicine, University of Uskudar, Istanbul, Turkey
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109
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Fiscon G, Conte F, Farina L, Paci P. SAveRUNNER: A network-based algorithm for drug repurposing and its application to COVID-19. PLoS Comput Biol 2021; 17:e1008686. [PMID: 33544720 PMCID: PMC7891752 DOI: 10.1371/journal.pcbi.1008686] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/18/2021] [Accepted: 01/10/2021] [Indexed: 02/06/2023] Open
Abstract
The novelty of new human coronavirus COVID-19/SARS-CoV-2 and the lack of effective drugs and vaccines gave rise to a wide variety of strategies employed to fight this worldwide pandemic. Many of these strategies rely on the repositioning of existing drugs that could shorten the time and reduce the cost compared to de novo drug discovery. In this study, we presented a new network-based algorithm for drug repositioning, called SAveRUNNER (Searching off-lAbel dRUg aNd NEtwoRk), which predicts drug-disease associations by quantifying the interplay between the drug targets and the disease-specific proteins in the human interactome via a novel network-based similarity measure that prioritizes associations between drugs and diseases locating in the same network neighborhoods. Specifically, we applied SAveRUNNER on a panel of 14 selected diseases with a consolidated knowledge about their disease-causing genes and that have been found to be related to COVID-19 for genetic similarity (i.e., SARS), comorbidity (e.g., cardiovascular diseases), or for their association to drugs tentatively repurposed to treat COVID-19 (e.g., malaria, HIV, rheumatoid arthritis). Focusing specifically on SARS subnetwork, we identified 282 repurposable drugs, including some the most rumored off-label drugs for COVID-19 treatments (e.g., chloroquine, hydroxychloroquine, tocilizumab, heparin), as well as a new combination therapy of 5 drugs (hydroxychloroquine, chloroquine, lopinavir, ritonavir, remdesivir), actually used in clinical practice. Furthermore, to maximize the efficiency of putative downstream validation experiments, we prioritized 24 potential anti-SARS-CoV repurposable drugs based on their network-based similarity values. These top-ranked drugs include ACE-inhibitors, monoclonal antibodies (e.g., anti-IFNγ, anti-TNFα, anti-IL12, anti-IL1β, anti-IL6), and thrombin inhibitors. Finally, our findings were in-silico validated by performing a gene set enrichment analysis, which confirmed that most of the network-predicted repurposable drugs may have a potential treatment effect against human coronavirus infections.
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Affiliation(s)
- Giulia Fiscon
- Institute for Systems Analysis and Computer Science “Antonio Ruberti”, National Research Council, Rome, Italy
- Fondazione per la Medicina Personalizzata, Genova, Italy
| | - Federica Conte
- Institute for Systems Analysis and Computer Science “Antonio Ruberti”, National Research Council, Rome, Italy
| | - Lorenzo Farina
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Paola Paci
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
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110
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Wang J, Wang D, Zhang Y, Dong J. Synthesis and Biopharmaceutical Applications of Sugar-Based Polymers: New Advances and Future Prospects. ACS Biomater Sci Eng 2021; 7:963-982. [PMID: 33523642 DOI: 10.1021/acsbiomaterials.0c01710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The rapid rise in research interest in carbohydrate-based polymers is undoubtedly due to the nontoxic nature of such materials in an in vivo environment and the versatile roles that the polymers can play in cellular functions. Such polymers have served as therapeutic tools for drug delivery, including antigens, proteins, and genes, as well as diagnostic devices. Our focus in the first half of this Review is on synthetic methods based on ring-opening polymerization and enzyme-catalyzed polymerization, along with controlled radical polymerization. In the second half of this Review, sugar-based polymers are discussed on the basis of their remarkable success in competitive receptor binding, as multifunctional nanocarriers of targeting inhibitors for cancer treatment, in genome-editing delivery, in immunotherapy based on endogenous antibody recruitment, and in treatment of respiratory diseases, including influenza A. Particular emphasis is put on the synthesis and biopharmaceutical applications of sugar-based polymers published in the most recent 5 years. A noticeable attribute of carbohydrate-based polymers is that the sugar-receptor interactions can be facilitated by the cooperative effect of multiple sugar units. Their diversified topology and structures will drive the development of new synthetic strategies and bring about important applications, including coronavirus-related drug therapy.
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Affiliation(s)
- Jie Wang
- College of Chemistry and Chemical Engineering, Shaoxing University, 508 Huancheng West Road, Shaoxing, Zhejiang Province 312000, China
| | - Dong Wang
- College of Chemistry and Chemical Engineering, Shaoxing University, 508 Huancheng West Road, Shaoxing, Zhejiang Province 312000, China
| | - Yixian Zhang
- College of Chemistry and Chemical Engineering, Shaoxing University, 508 Huancheng West Road, Shaoxing, Zhejiang Province 312000, China
| | - Jian Dong
- College of Chemistry and Chemical Engineering, Shaoxing University, 508 Huancheng West Road, Shaoxing, Zhejiang Province 312000, China
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111
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Lucatelli P, Rocco B, Nardis PG, Cannavale A, Bezzi M, Catalano C, Corona M. Bleeding in COVID Patients: What We Have Understood So Far. Cardiovasc Intervent Radiol 2021; 44:666-668. [PMID: 33511426 PMCID: PMC7843001 DOI: 10.1007/s00270-021-02775-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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112
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D'Amato G, Acanfora L, Paoli LD, D'Amato M. Authors' response to the Letter to the Editor regarding: Preventive home therapy for symptomatic patients affected by COVID-19 and followed by teleconsultations. Multidiscip Respir Med 2021; 16:768. [PMID: 33907626 PMCID: PMC8056324 DOI: 10.4081/mrm.2021.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Dear Editor, We have carefully read the comments by Adiletta and colleagues...
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty “A. Cardarelli” Hospital, Naples
| | - Luca Acanfora
- Managing Director of the Covid-19 nasopharyngeal testing project, for the cooperation agreement between High Specialization in Infectious Diseases “Cotugno Hospital” and “Sovereign Military of Malta” in Naples, Federico II University of Naples
| | | | - Maria D'Amato
- First Division of Pneumology, “V. Monaldi” High Specialty Hospital and Federico II University of Naples, Italy
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113
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Ginsburg I, Fibach E. Polycations and polyanions in SARS-CoV-2 infection. Med Hypotheses 2021; 146:110470. [PMID: 33412501 PMCID: PMC7837050 DOI: 10.1016/j.mehy.2020.110470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023]
Abstract
We hypothesize that polycations, such as nuclear histones, released by neutrophils COVID-19 aggravate COVID-19 by multiple mechanisms: (A) Neutralization of the electrostatic repulsion between the virus particles and the cell membrane, thereby enhancing receptor-mediated entry. (B) Binding to the virus particles, thereby inducing opsonin-mediated endocytosis. (C) Adding to the cytotoxicity, in conjunction with oxidants, cytokines and other pro-inflammatory substances secreted by cells of the innate immunity system. These effects may be alleviated by the administration of negatively charged polyanions such as heparins and heparinoids.
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Affiliation(s)
- I Ginsburg
- The Hebrew University - Hadassah School of Medicine, The Faculty of Dental Medicine, The Ein-Kerm Campus, Jerusalem, Israel
| | - E Fibach
- The Hebrew University - Hadassah School of Medicine, Department of Hematology, The Ein-Kerm Campus, Jerusalem, Israel.
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114
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Stathis C, Victoria N, Loomis K, Nguyen SA, Eggers M, Septimus E, Safdar N. Review of the use of nasal and oral antiseptics during a global pandemic. Future Microbiol 2021; 16:119-130. [PMID: 33464122 PMCID: PMC7842245 DOI: 10.2217/fmb-2020-0286] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
A review of nasal sprays and gargles with antiviral properties suggests that a number of commonly used antiseptics including povidone-iodine, Listerine®, iota-carrageenan and chlorhexidine should be studied in clinical trials to mitigate both the progression and transmission of SARS-CoV-2. Several of these antiseptics have demonstrated the ability to cut the viral load of SARS-CoV-2 by 3-4 log10 in 15-30 s in vitro. In addition, hypertonic saline targets viral replication by increasing hypochlorous acid inside the cell. A number of clinical trials are in process to study these interventions both for prevention of transmission, prophylaxis after exposure, and to diminish progression by reduction of viral load in the early stages of infection.
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Affiliation(s)
| | | | | | - Shaun A Nguyen
- Department of Otolaryngology, Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Maren Eggers
- Prof Dr G Enders MVZ Laboratory & Institute of Virology, Infectious Diseases, Stuttgart, BW 70193, Germany
| | - Edward Septimus
- Department of Population Medicine, Harvard Medical School & the Harvard Pilgrim Healthcare Institute, Boston, MA 02215, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA & The William S Middleton Memorial Veterans Hospital, Madison, WI 53726, USA
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115
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Zhang Y, Tang LV. Overview of Targets and Potential Drugs of SARS-CoV-2 According to the Viral Replication. J Proteome Res 2021; 20:49-59. [PMID: 33347311 PMCID: PMC7770889 DOI: 10.1021/acs.jproteome.0c00526] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 01/18/2023]
Abstract
Since the novel coronavirus pandemic, people around the world have been touched in varying degrees, and this pandemic has raised a major global health concern. As there is no effective drug or vaccine, it is urgent to find therapeutic drugs that can serve to deal with the current epidemic situation in all countries and regions. We searched drugs and response measures for SARS-CoV-2 in the PubMed database, and then updated the potential targets and therapeutic drugs from the perspective of the viral replication cycle. The drug research studies of the viral replication cycle are predominantly focused on the process of the virus entering cells, proteases, and RdRp. The inhibitors of the virus entry to cells and RdRp, such as Arbidol, remdesivir, favipiravir, EIDD-2081, and ribavirin, are in clinical trials, while most of the protease inhibitors are mainly calculated by molecular docking technology, which needs in vivo and in vitro experiments to prove the effect for SARS-CoV-2. This review summarizes the drugs targeting the viral replication process and provides a basis and directions for future drug development and reuse on the protein level of COVID-19.
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Affiliation(s)
- Yi Zhang
- Institute
of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Liang V. Tang
- Institute
of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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116
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Recent Clinical Trials on Natural Products and Traditional Chinese Medicine Combating the COVID-19. Indian J Microbiol 2020; 61:10-15. [PMID: 33390627 PMCID: PMC7772620 DOI: 10.1007/s12088-020-00919-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing potentially fatal coronavirus disease-19 (COVID-19), with a significant health and economic burden around the globe. Currently many clinical studies are undergoing but still there is no any specific approved therapy or drug established for effective treatment of COVID-19. This review aimed to analyses various clinical studies which have been registered in www.clinicaltrials.gov and http://www.chictr.org.cn were registered with natural plant-based medicines and Traditional Chinese medicine (TCM) for discovering effective treatment and prevention of COVID-19. Total 46 and 64 natural drug and TCM interventions were identified which mainly determined the preventive strategies and possible treatments for COVID-19 infection. We identified that most of the clinical trial undergoing on natural compound like heparin and vitamin C as therapeutic agents and immune boosters for against COVID-19. Traditional Chinese medicines and herbal medicines can be effectively used as a preventive therapy against COVID-19 and after successful clinical trials and these potential therapies can be promoted by countries around the world.
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117
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Barkoff CM, Mousa SA. Pharmacotherapy in COVID 19: Potential Impact of Targeting the Complement System. Biomedicines 2020; 9:11. [PMID: 33374356 PMCID: PMC7823480 DOI: 10.3390/biomedicines9010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory illness caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has claimed over one million lives worldwide since December 2019. The complement system, while a first-line immune defense against invading pathogens, has off-target effects that lead to increases in inflammation, tissue damage, and thrombosis; these are common, life-threatening complications seen in patients with COVID-19. This review explores the potential impact of complement activation in COVID-19 and possible treatments targeting the complement system.
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Affiliation(s)
| | - Shaker A. Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144, USA;
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118
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Higgins V, Sohaei D, Diamandis EP, Prassas I. COVID-19: from an acute to chronic disease? Potential long-term health consequences. Crit Rev Clin Lab Sci 2020; 58:297-310. [PMID: 33347790 DOI: 10.1080/10408363.2020.1860895] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite pulmonary impairments being the most prevalent, extra-pulmonary manifestations of COVID-19 are abundant. Confirmed COVID-19 cases have now surpassed 57.8 million worldwide as of 22 November 2020. With estimated case fatality rates (number of deaths from COVID-19 divided by number of confirmed COVID-19 cases) varying between 1 and 7%, there will be a large population of recovered COVID-19 patients that may acquire a multitude of long-term health consequences. While the multi-organ manifestations of COVID-19 are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. In this review, we turn to previous similar coronaviruses (i.e. SARS-CoV-1 and Middle East respiratory syndrome coronavirus [MERS-CoV]) in combination with known health implications of SARS-CoV-2 infection to predict potential long-term effects of COVID-19, including pulmonary, cardiovascular, hematologic, renal, central nervous system, gastrointestinal, and psychosocial manifestations, in addition to the well-known post-intensive care syndrome. It is necessary to monitor COVID-19 patients after discharge to understand the breadth and severity of long-term effects. This can be accomplished by repurposing or initiating large cohort studies to not only focus on the long-term consequences of SARS-CoV-2 infection, but also on acquired immune function as well as ethno-racial group and household income disparities in COVID-19 cases and hospitalizations. The future for COVID-19 survivors remains uncertain, and if this virus circulates among us for years to come, long-term effects may accumulate exponentially.
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Affiliation(s)
- Victoria Higgins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Dorsa Sohaei
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.,Department of Clinical Biochemistry, University Health Network, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ioannis Prassas
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
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119
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Bamgboje A, Hong J, Mushiyev S, Pekler G. A 61-Year-Old Man with SARS-CoV-2 Infection and Venous Thrombosis Presenting with Painful Swelling and Gangrene of the Lower Limb Consistent with Phlegmasia Cerulea Dolens. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928342. [PMID: 33323917 PMCID: PMC7750909 DOI: 10.12659/ajcr.928342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Male, 61-year-old Final Diagnosis: Phlegmasia cerulea dolens Symptoms: Bilateral leg swelling • breathlessness • cough • fever Medication: — Clinical Procedure: — Specialty: Cardiology • Infectious Diseases • Medicine, General and Internal
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Affiliation(s)
- Abayomi Bamgboje
- Department of Internal Medicine, NYC Health+Hospitals/Metropolitan, New York City, NY, USA
| | - Jungrak Hong
- Department of Internal Medicine, NYC Health+Hospitals/Metropolitan, New York City, NY, USA
| | - Savi Mushiyev
- Department of Cardiology, NYC Health+Hospitals/Metropolitan, New York City, NY, USA
| | - Gerald Pekler
- Department of Cardiology, NYC Health+Hospitals/Metropolitan, New York City, NY, USA
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120
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Dhama K, Patel SK, Natesan S, Vora KS, Iqbal Yatoo M, Tiwari R, Saxena SK, Singh KP, Singh R, Malik YS. COVID-19 in the elderly people and advances in vaccination approaches. Hum Vaccin Immunother 2020; 16:2938-2943. [PMID: 33270497 DOI: 10.1080/21645515.2020.1842683] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The rapid worldwide spread of the COVID-19 pandemic, caused by the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in tens of millions of infections and over one million deaths. SARS-CoV-2 infection affects all age groups; however, those over 60 years old are affected more severely. Moreover, pre-existing co-morbidities result in higher COVID-19-associated mortality in the geriatric population. This article highlights the associated risk factors of SARS-CoV-2 infection in older people and progress in developing COVID-19 vaccines, especially for efficient vaccination of the older population. There is also a summary of immunomodulatory and immunotherapeutic approaches to ameliorate the outcome of COVID-19 in older individuals.
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Affiliation(s)
- Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly, Uttar Pradesh, India
| | - Shailesh Kumar Patel
- Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly, Uttar Pradesh, India
| | - Senthilkumar Natesan
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar , Ganghinagar, Gujarat, India
| | - Kranti Suresh Vora
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar , Ganghinagar, Gujarat, India.,Health Research Institut, University of Canberra, ACT , Australia
| | - Mohd Iqbal Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir , Srinagar, Jammu and Kashmir, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU) , Mathura, India
| | - Shailendra K Saxena
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU) , Lucknow, India
| | - Karam Pal Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly, Uttar Pradesh, India
| | - Rajendra Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly, Uttar Pradesh, India
| | - Yashpal Singh Malik
- Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly, Uttar Pradesh, India
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121
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COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol 2020; 113:45-57. [PMID: 33161508 PMCID: PMC7648664 DOI: 10.1007/s12185-020-03029-y] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in d-dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by d-dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID-19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study
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122
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Shi C, Wang C, Wang H, Yang C, Cai F, Zeng F, Cheng F, Liu Y, Zhou T, Deng B, Vlodavsky I, Li JP, Zhang Y. The Potential of Low Molecular Weight Heparin to Mitigate Cytokine Storm in Severe COVID-19 Patients: A Retrospective Cohort Study. Clin Transl Sci 2020; 13:1087-1095. [PMID: 32881340 PMCID: PMC7719364 DOI: 10.1111/cts.12880] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
On March 11, 2020, the World Health Organization declared its assessment of coronavirus disease 2019 (COVID-19) as a global pandemic. However, specific anti-severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) drugs are still under development, and patients are managed by multiple complementary treatments. We performed a retrospective analysis to compare and evaluate the effect of low molecular weight heparin (LMWH) treatment on disease progression. For this purpose, the clinical records and laboratory indicators were extracted from electronic medical records of 42 patients with COVID-19 (21 of whom were treated with LMWH, and 21 without LMWH) hospitalized (Union Hospital of Huazhong University of Science and Technology) from February 1 to March 15, 2020. Changes in the percentage of lymphocytes before and after LMWH treatment were significantly different from those in the control group (P = 0.011). Likewise, changes in the levels of D-dimer and fibrinogen degradation products in the LMWH group before and after treatment were significantly different from those in the control group (P = 0.035). Remarkably, IL-6 levels were significantly reduced after LMWH treatment (P = 0.006), indicating that, besides other beneficial properties, LMWH may exert an anti-inflammatory effect and attenuate in part the "cytokine storm" induced by the virus. Our results support the use of LMWH as a potential therapeutic drug for the treatment of COVID-19, paving the way for a subsequent well-controlled clinical study.
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Affiliation(s)
- Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, China
| | - Cong Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanxiang Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Yang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Zeng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Cheng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihui Liu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taotao Zhou
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Deng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Israel Vlodavsky
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Israel
| | - Jin-Ping Li
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, China
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123
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Frazer JS, Tyrynis Everden AJ. Emerging patterns of hypercoagulability associated with critical COVID-19: A review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020; 34:4-13. [PMID: 38620391 PMCID: PMC7346831 DOI: 10.1016/j.tacc.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
While the COVID-19 pandemic sweeps the world, much evidence is being gathered regarding its novel pathological mechanisms. It is the authors' clinical experience that patients in the intensive care unit suffering from COVID-19 are extremely pro-coagulable, with venous and arterial thromboembolism frequently observed, and losses of vascular access lines and filtration circuits to thrombosis now commonplace. Here, we explore the evidence for hypercoagulability in this group, presenting evidence of both a localised pulmonary hypercoagulability, and a systemic hypercoagulability resulting in thrombosis distant to the pulmonary vasculature. Furthermore, we discuss the possible risk factors exacerbated by, or selected for in COVID-19. We review the available evidence for use of plasma D-dimer as a prognostic marker, exploring the possibility that it acts as a marker of a COVID-19-associated hypercoagulability. We review the evidence for a pro-coagulant subtype of disseminated intravascular coagulation, discussing its clinical significance. Finally, we discuss the current evidence surrounding treatment of COVID-19 hypercoagulability, including prophylactic and treatment-dose heparin, thrombolytic agents, antiplatelet agents, and direct thrombin inhibitors, among others. We suggest areas in which further investigation is urgently needed to reduce the startling incidence of thrombosis in this group, a complication no doubt contributing to morbidity and mortality.
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Affiliation(s)
- John Scott Frazer
- Somerville College, University of Oxford, Woodstock Road, Oxford, OX2 6HD, UK
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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124
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Drago F, Gozzo L, Li L, Stella A, Cosmi B. Use of Enoxaparin to Counteract COVID-19 Infection and Reduce Thromboembolic Venous Complications: A Review of the Current Evidence. Front Pharmacol 2020; 11:579886. [PMID: 33041824 PMCID: PMC7525088 DOI: 10.3389/fphar.2020.579886] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023] Open
Abstract
The impact of the COVID-19 pandemic has been dramatic worldwide, with China, Italy, and now US at its epicenter. Researchers and clinicians are studying and testing different approaches in the attempt to prevent the infection and minimize its severity. Major efforts are focused on optimizing mechanical ventilation, antiviral, and supportive treatment; however, the role of heparin and low molecular weight (LMW) heparin in this setting has been largely overlooked. This review summarizes the available evidence about the role of heparan sulfate as a key entry mechanism for SARS-CoV-2; the efficacy of heparin and LMW heparin in counteracting its entry into the cell, the recent experimental findings obtained in in vitro studies using the LMW heparin enoxaparin Inhixa®, the role of heparin and LMW heparin in modulating the cytokine storm, and the evidence for the use of LMW heparin in the prevention and treatment of the thromboembolic complications of COVID-19. The available evidence suggests that LMW heparin appears as a promising tool in the treatment of COVID-19. Whether its systematic use is associated with a reduction in complications and ultimately mortality of these patients is being tested in several studies starting worldwide.
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Affiliation(s)
- Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Lucia Gozzo
- Department of Biomedical and Biotechnological Sciences, University Hospital of Catania, Catania, Italy
| | - Li Li
- Laboratory Hepalink, Shenzen, China
| | - Andrea Stella
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Benilde Cosmi
- Division of Angiology and Blood Coagulation, Department of Specialty Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
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125
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Bodine SC, Morty RE. World Lung Day 2020 at the Journal of Applied Physiology and the American Journal of Physiology-Lung Cellular and Molecular Physiology. Am J Physiol Lung Cell Mol Physiol 2020; 319:L534-L537. [PMID: 32755315 PMCID: PMC7518059 DOI: 10.1152/ajplung.00371.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Sue C Bodine
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rory E Morty
- Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center, Justus Liebig University Giessen, member of the German Center for Lung Research (DZL), Giessen, Germany
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126
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Kehinde TA, Osundiji MA. Sickle cell trait and the potential risk of severe coronavirus disease 2019-A mini-review. Eur J Haematol 2020; 105:519-523. [PMID: 32589774 PMCID: PMC7361772 DOI: 10.1111/ejh.13478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus Disease 2019 (COVID‐19) pandemic is a rapidly evolving public health problem. The severity of COVID‐19 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism with subsequent mortality. An improved understanding of risk factors for adverse clinical outcomes may shed some light on novel personalized approaches to optimize clinical care in vulnerable populations. Emerging trends in the United States suggest possibly higher mortality rates of COVID‐19 among African Americans, although detailed epidemiological study data is pending. Sickle cell disease (SCD) disproportionately affects Black/African Americans in the United States as well as forebearers from sub‐Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America), and some Mediterranean countries. The carrier frequency for SCD is high among African Americans. This article underscores the putative risks that may be associated with COVID‐19 pneumonia in sickle cell trait as well as potential opportunities for individualized medical care in the burgeoning era of personalized medicine.
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Affiliation(s)
| | - Mayowa Azeez Osundiji
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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127
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Bentivegna E, Luciani M, Spuntarelli V, Speranza ML, Guerritore L, Sentimentale A, Martelletti P. Extremely Severe Case of COVID-19 Pneumonia Recovered Despite Bad Prognostic Indicators: a Didactic Report. ACTA ACUST UNITED AC 2020; 2:1204-1207. [PMID: 32838153 PMCID: PMC7324074 DOI: 10.1007/s42399-020-00383-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/20/2023]
Abstract
COVID-19 is a highly infectious respiratory disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Starting from Wuhan (China) where it was firstly reported, it rapidly spread to the rest of the world, causing a pandemic with more than 300,000 deaths to date. We report an extremely severe case of coronavirus pneumonia in an over 80-year-old patient with hypertension, coronary heart disease, chronic heart failure, and chronic obstructive pulmonary disease. Despite a clearly poor anamnestic and clinical prognostic forecast, she was successfully discharged thanks to a careful evaluation of the case and of the complications that have arisen. Although a higher vulnerability of geriatric patients has been observed, the literature on elderly COVID-19 patients has remained very scarce, especially in those over 80. The article aims to explore factors that may allow the successful outcome and provides important elements to better understand this disease.
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Affiliation(s)
- Enrico Bentivegna
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - M Luciani
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - V Spuntarelli
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - M L Speranza
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - L Guerritore
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - A Sentimentale
- Emergency Medicine CoViD-19 Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - P Martelletti
- Emergency Medicine CoViD-19 Unit, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
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128
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Wijaya I, Andhika R, Huang I. The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review. Clin Appl Thromb Hemost 2020; 26:1076029620960797. [PMID: 33079569 PMCID: PMC7791436 DOI: 10.1177/1076029620960797] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
The incidence of venous thromboembolism (VTE) events in patients with COVID-19 treated with a standard thromboprophylaxis dose of anticoagulants remains high. We conducted a systematic review in order to explore the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19. A systematic search was carried out using the electronic databases of PubMed, EuropePMC, and the Cochrane Central Database, using specific keywords. All articles that fulfilled the inclusion criteria were included in the qualitative analysis. There were 8 observational studies included in the final qualitative analysis. Quality assessment using the Newcastle-Ottawa Scale (NOS) showed a mean score of 7.5 ± 1.06, indicating moderate to high quality of the studies. Three retrospective cohort studies reported a reduction in the mortality rate, while 6 other studies showed no mortality benefits among patients with COVID-19 treated with therapeutic-dose anticoagulation. There was a slight tendency toward a reduction in the mortality rate among mechanically-ventilated patients with COVID-19 receiving therapeutic-dose anticoagulation. Bleeding events and thrombotic complications among patients receiving therapeutic-dose anticoagulation were reported in 3 studies. Although it is too soon to draw any conclusions, this systematic review draws attention to current evidence regarding the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19.
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Affiliation(s)
- Indra Wijaya
- Division of Hematology and Medical Oncology, Department of Internal
Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General
Hospital, Bandung, Indonesia
| | - Rizky Andhika
- Department of Internal Medicine, Faculty of Medicine, Universitas
Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ian Huang
- Department of Internal Medicine, Faculty of Medicine, Universitas
Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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