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Viral Coagulopathy in Patients With COVID-19: Treatment and Care.
Clin Appl Thromb Hemost. 2020 Jan-Dec; 26:1076029620936776.CA

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.

Authors+Show Affiliations

NY Cardiovascular Research, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Ochsner Clinical School, University of Queensland, AU and Ochsner Medical Center, New Orleans, LA, USA.NYU Langone Health, New York, NY, USA.Department of Pathology, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.London Northwest University Health Care NHS Trust, London, United Kingdom. Imperial College of Science, Technology and Medicine, London, United Kingdom.Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.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.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32687449

Citation

Kipshidze, Nickolas, et al. "Viral Coagulopathy in Patients With COVID-19: Treatment and Care." Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, vol. 26, 2020, p. 1076029620936776.
Kipshidze N, Dangas G, White CJ, et al. Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Clin Appl Thromb Hemost. 2020;26:1076029620936776.
Kipshidze, N., Dangas, G., White, C. J., Kipshidze, N., Siddiqui, F., Lattimer, C. R., Carter, C. A., & Fareed, J. (2020). Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 26, 1076029620936776. https://doi.org/10.1177/1076029620936776
Kipshidze N, et al. Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620936776. PubMed PMID: 32687449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Viral Coagulopathy in Patients With COVID-19: Treatment and Care. AU - Kipshidze,Nickolas, AU - Dangas,George, AU - White,Christopher J, AU - Kipshidze,Nodar, AU - Siddiqui,Fakiha, AU - Lattimer,Christopher R, AU - Carter,Charles A, AU - Fareed,Jawed, PY - 2020/7/21/entrez PY - 2020/7/21/pubmed PY - 2020/8/1/medline KW - COVID-19 KW - acute respiratory distress syndrome (ARDS) KW - coagulopathy KW - disseminated intravascular coagulation (DIC) KW - thrombosis SP - 1076029620936776 EP - 1076029620936776 JF - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JO - Clin. Appl. Thromb. Hemost. VL - 26 N2 - 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. SN - 1938-2723 UR - https://www.unboundmedicine.com/medline/citation/32687449/Viral_Coagulopathy_in_Patients_With_COVID_19:_Treatment_and_Care_ L2 - https://journals.sagepub.com/doi/10.1177/1076029620936776?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -