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Kipshidze N, Dangas G, White CJ, Kipshidze N, Siddiqui F, Lattimer CR, Carter CA, Fareed J. Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Clin Appl Thromb Hemost 2020; 26:1076029620936776. [PMID: 32687449 PMCID: PMC7461127 DOI: 10.1177/1076029620936776] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
COVID-19 has proven to be particularly challenging given the complex
pathogenesis of SARS-CoV-2. Early data have demonstrated how the host
response to this novel coronavirus leads to the proliferation of
pro-inflammatory cytokines, massive endothelial damage, and
generalized vascular manifestations. While SARS-CoV-2 primarily
targets the upper and lower respiratory tract, other organ systems are
also affected. SARS-CoV-2 relies on 2 host cell receptors for
successful attachment: angiotensin-converting enzyme 2 and
transmembrane protease serine 2. Clinicopathologic reports have
demonstrated associations between severe COVID-19 and viral
coagulopathy, resulting in pulmonary embolism; venous, arterial, and
microvascular thrombosis; lung endothelial injury; and associated
thrombotic complications leading to acute respiratory distress
syndrome. Viral coagulopathy is not novel given similar observations
with SARS classic, including the consumption of platelets, generation
of thrombin, and increased fibrin degradation product exhibiting overt
disseminated intravascular coagulation–like syndrome. The specific
mechanism(s) behind the thrombotic complications in COVID-19 patients
has yet to be fully understood. Parenteral anticoagulants, such as
heparin and low-molecular-weights heparins, are widely used in the
management of COVID-19 patients. Beyond the primary (anticoagulant)
effects of these agents, they may exhibit antiviral,
anti-inflammatory, and cytoprotective effects. Direct oral
anticoagulants and antiplatelet agents are also useful in the
management of these patients. Tissue plasminogen activator and other
fibrinolytic modalities may also be helpful in the overall management.
Catheter-directed thrombolysis can be used in patients developing
pulmonary embolism. Further investigations are required to understand
the molecular and cellular mechanisms involved in the pathogenesis of
COVID-19-associated thrombotic complications.
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Affiliation(s)
| | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher J White
- Ochsner Clinical School, University of Queensland, AU and Ochsner Medical Center, New Orleans, LA, USA
| | | | - Fakiha Siddiqui
- Department of Pathology, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Christopher R Lattimer
- London Northwest University Health Care NHS Trust, London, United Kingdom.,Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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