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Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia.
J Vasc Surg Venous Lymphat Disord. 2020 Sep; 8(5):711-716.JV

Abstract

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.

Authors+Show Affiliations

Angiology Unit, San Marco Hospital, Department of Cardiovascular Disease, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy. Electronic address: lucacost84@gmail.com.Angiology Unit, San Marco Hospital, Department of Cardiovascular Disease, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.Angiology Unit, San Marco Hospital, Department of Cardiovascular Disease, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.Vascular Center, Nuova Villa Claudia, Rome, Italy.Department of Medicine, University of Verona, Verona, Italy.Angiology Unit, San Marco Hospital, Department of Cardiovascular Disease, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32561465

Citation

Costanzo, Luca, et al. "Coagulopathy, Thromboembolic Complications, and the Use of Heparin in COVID-19 Pneumonia." Journal of Vascular Surgery. Venous and Lymphatic Disorders, vol. 8, no. 5, 2020, pp. 711-716.
Costanzo L, Palumbo FP, Ardita G, et al. Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia. J Vasc Surg Venous Lymphat Disord. 2020;8(5):711-716.
Costanzo, L., Palumbo, F. P., Ardita, G., Antignani, P. L., Arosio, E., & Failla, G. (2020). Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 8(5), 711-716. https://doi.org/10.1016/j.jvsv.2020.05.018
Costanzo L, et al. Coagulopathy, Thromboembolic Complications, and the Use of Heparin in COVID-19 Pneumonia. J Vasc Surg Venous Lymphat Disord. 2020;8(5):711-716. PubMed PMID: 32561465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coagulopathy, thromboembolic complications, and the use of heparin in COVID-19 pneumonia. AU - Costanzo,Luca, AU - Palumbo,Francesco Paolo, AU - Ardita,Giorgio, AU - Antignani,Pier Luigi, AU - Arosio,Enrico, AU - Failla,Giacomo, AU - ,, Y1 - 2020/06/17/ PY - 2020/04/16/received PY - 2020/05/22/accepted PY - 2020/6/21/pubmed PY - 2020/8/28/medline PY - 2020/6/21/entrez KW - COVID-19 KW - Coagulopathy KW - D-dimer KW - Low-molecular-weight heparin KW - Pneumonia KW - Thrombosis SP - 711 EP - 716 JF - Journal of vascular surgery. Venous and lymphatic disorders JO - J Vasc Surg Venous Lymphat Disord VL - 8 IS - 5 N2 - 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. SN - 2213-3348 UR - https://www.unboundmedicine.com/medline/citation/32561465/Coagulopathy_thromboembolic_complications_and_the_use_of_heparin_in_COVID_19_pneumonia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-333X(20)30342-5 DB - PRIME DP - Unbound Medicine ER -