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Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies.
Ann Hematol. 2020 Sep; 99(9):1953-1965.AH

Abstract

In October 2019, a viral infectious disease appeared in the city of Wuhan in China. A new betacoronavirus, SARS-CoV-2, has been recognized as the responsible pathogen in this infection. Although coronavirus disease is principally expressed as a pulmonary infection, critical SARS-CoV-2 infection is frequently complicated with coagulopathy, and thromboembolic events are recognizable in several patients. Dehydration, acute inflammatory condition, protracted immobilization during disease, existence of multiple cardiovascular risk factors such as diabetes, obesity or hypertension, previous coronary artery disease, ischemic stroke, peripheral artery disease are frequent comorbidities in SARS-CoV-2 hospitalized subjects, which possibly augment thrombo-embolic risk. However, other causal factors can still be identified such as unrestricted angiotensin II action, the use of immunoglobulins, an increased production of adhesion molecules able to induce vascular inflammation and endothelial activation, complement stimulation, excessive production of neutrophil extracellular traps (NETs), and increased platelet count. Low-molecular-weight heparin should be chosen as early treatment because of its anti-inflammatory action and its ability to antagonize histones and so defend the endothelium. However, several therapeutic possibilities have also been proposed such as fibrinolytic treatment, drugs that target NETs, and complement inhibition. Nevertheless, although the violence of the pandemic may suggest the use of heroic treatments to reduce the frightening mortality that accompanies SARS-CoV-2 infection, we believe that experimental treatments should only be used within approved and controlled protocols, the only ones that can provide useful and specify information on the validity of the treatments.

Authors+Show Affiliations

Division of Haematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98125, Messina, Italy. aallegra@unime.it. COVID Centre AOU Policlinic G. Martino, Messina, Italy. aallegra@unime.it.Division of Haematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98125, Messina, Italy.Division of Haematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98125, Messina, Italy.Division of Haematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98125, Messina, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32671455

Citation

Allegra, Alessandro, et al. "Coagulopathy and Thromboembolic Events in Patients With SARS-CoV-2 Infection: Pathogenesis and Management Strategies." Annals of Hematology, vol. 99, no. 9, 2020, pp. 1953-1965.
Allegra A, Innao V, Allegra AG, et al. Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies. Ann Hematol. 2020;99(9):1953-1965.
Allegra, A., Innao, V., Allegra, A. G., & Musolino, C. (2020). Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies. Annals of Hematology, 99(9), 1953-1965. https://doi.org/10.1007/s00277-020-04182-4
Allegra A, et al. Coagulopathy and Thromboembolic Events in Patients With SARS-CoV-2 Infection: Pathogenesis and Management Strategies. Ann Hematol. 2020;99(9):1953-1965. PubMed PMID: 32671455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies. AU - Allegra,Alessandro, AU - Innao,Vanessa, AU - Allegra,Andrea Gaetano, AU - Musolino,Caterina, Y1 - 2020/07/15/ PY - 2020/04/26/received PY - 2020/07/13/accepted PY - 2020/7/17/pubmed PY - 2020/8/18/medline PY - 2020/7/17/entrez KW - Coagulation KW - Complement activation KW - Disseminated intravascular coagulation KW - Low-molecular-weight heparin KW - Neutrophil extracellular traps KW - SARS-Cov-2 SP - 1953 EP - 1965 JF - Annals of hematology JO - Ann Hematol VL - 99 IS - 9 N2 - In October 2019, a viral infectious disease appeared in the city of Wuhan in China. A new betacoronavirus, SARS-CoV-2, has been recognized as the responsible pathogen in this infection. Although coronavirus disease is principally expressed as a pulmonary infection, critical SARS-CoV-2 infection is frequently complicated with coagulopathy, and thromboembolic events are recognizable in several patients. Dehydration, acute inflammatory condition, protracted immobilization during disease, existence of multiple cardiovascular risk factors such as diabetes, obesity or hypertension, previous coronary artery disease, ischemic stroke, peripheral artery disease are frequent comorbidities in SARS-CoV-2 hospitalized subjects, which possibly augment thrombo-embolic risk. However, other causal factors can still be identified such as unrestricted angiotensin II action, the use of immunoglobulins, an increased production of adhesion molecules able to induce vascular inflammation and endothelial activation, complement stimulation, excessive production of neutrophil extracellular traps (NETs), and increased platelet count. Low-molecular-weight heparin should be chosen as early treatment because of its anti-inflammatory action and its ability to antagonize histones and so defend the endothelium. However, several therapeutic possibilities have also been proposed such as fibrinolytic treatment, drugs that target NETs, and complement inhibition. Nevertheless, although the violence of the pandemic may suggest the use of heroic treatments to reduce the frightening mortality that accompanies SARS-CoV-2 infection, we believe that experimental treatments should only be used within approved and controlled protocols, the only ones that can provide useful and specify information on the validity of the treatments. SN - 1432-0584 UR - https://www.unboundmedicine.com/medline/citation/32671455/Coagulopathy_and_thromboembolic_events_in_patients_with_SARS_CoV_2_infection:_pathogenesis_and_management_strategies_ L2 - https://dx.doi.org/10.1007/s00277-020-04182-4 DB - PRIME DP - Unbound Medicine ER -