Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies.
Alessandro AllegraVanessa InnaoAndrea Gaetano AllegraCaterina MusolinoPublished in: Annals of hematology (2020)
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.
Keyphrases
- sars cov
- respiratory syndrome coronavirus
- coronavirus disease
- angiotensin ii
- cardiovascular risk factors
- coronary artery disease
- type diabetes
- peripheral artery disease
- oxidative stress
- metabolic syndrome
- atrial fibrillation
- cardiovascular disease
- blood pressure
- cardiovascular events
- anti inflammatory
- vascular smooth muscle cells
- insulin resistance
- pulmonary hypertension
- infectious diseases
- weight gain
- newly diagnosed
- mental health
- angiotensin converting enzyme
- healthcare
- venous thromboembolism
- endothelial cells
- heart failure
- body mass index
- acute coronary syndrome
- health information
- escherichia coli
- combination therapy
- aortic valve
- coronary artery bypass grafting
- skeletal muscle
- high fat diet induced
- left ventricular
- hepatitis b virus
- replacement therapy