Changing physicians’ attitudes regarding anticoagulant therapy for novel coronavirus infection in 2021.

2021 ◽  
Author(s):  
Е.В. Ройтман ◽  
С.М. Маркин ◽  
П.Ф. Кравцов ◽  
К.В. Мазайшвили
Keyword(s):  
Anticoagulant Therapy ◽  
Process Development ◽  
Oral Anticoagulants ◽  
Vascular Diseases ◽  
Medical Community ◽  
Treatment And Prevention ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Thrombotic Complications ◽  
Novel Coronavirus

Введение. Несмотря на комплекс противоэпидемических мероприятий, включающих и массовую вакцинацию, распространение COVID-19-инфекции во второй половине 2021 г. продолжается. Отчасти это обусловлено появлением новых, более агрессивных штаммов. Так или иначе, поступление вируса SARS-CoV-2 в организм человека по-прежнему сопровождается развитием COVID-19-ассоциированной коагулопатии, реализующейся в различных тромботических осложнениях. Актуальные клинические рекомендации уже 12-го пересмотра описывают основные подходы к лечению и профилактике венозных тромбоэмболических осложнений, однако реализация их не всегда представляется возможной. Несмотря на растущую информированность клиницистов относительно патогенетических аспектов развития инфекционного процесса, в реальной практике все также имеет место значительное количество отклонений и нарушений, в том числе носящих системный характер, во многом связанных с избыточным желанием предотвратить отдельные из них. Цель исследования: изучение изменения состояния реальной клинической практики в области лечения и профилактики развития тромботических осложнений у пациентов, страдающих новой COVID-19-инфекцией. Материалы и методы. В основе работы – 2 анонимных опроса, проведенных в феврале и августе 2021 г., в которых приняли участие врачи-специалисты (соответственно, 223 и 131), занимающиеся лечением пациентов с хроническими и острыми заболеваниями сосудов. В опросник было включено 17 вопросов, описывающих отношение врачей к проблеме, касающихся выбора тактики лечения, применения фармацевтических препаратов и методов контроля системы гемостаза. Результаты. Результаты опросов выявили сохраняющуюся высокую степень информированности медицинского сообщества об увеличении риска тромботических осложнений при COVID-19 и необходимости коррекции COVID-19-ассоциированной коагулопатии путем назначения адекватной антикоагулянтной терапии (АКТ). Максимальную степень доверия среди респондентов при АКТ в условиях стационара сохраняют низкомолекулярные гепарины (НМГ), хотя растет количество врачей, рекомендующих новые (прямые) оральные антикоагулянты (НОАК/ПОАК), несмотря на отсутствие качественных рандомизированных исследований, подтверждающих их эффективность. Зафиксирован рост информированности респондентов в вопросах, касающихся лабораторного контроля за системой гемостаза. Заключение. Полученные результаты свидетельствуют о необходимости продолжения информационной кампании в отношении профилактики COVID-19-ассоциированной коагулопатии среди медицинских работников. Background. Despite a set of anti-epidemic measures, including mass vaccination, the spread of COVID-19-infection in the second half of 2021 continues. This is largely due to the emergence of new, more aggressive strains. One way or another, entry of SARS-CoV-2 virus into human body is still accompanied by development of COVID-19-associated coagulopathy realized in various thrombotic complications. Current clinical guidelines, already the 12th revision, describe the main approaches to treatment and prevention of venous thromboembolic complications, but their implementation is not always possible. Despite the increasing awareness of clinicians concerning pathogenetic aspects of infectious process development, a significant number of deviations and disorders, including those of systemic nature, still occur in real practice largely due to excessive desire to prevent some of them. Objectives: to study real clinical practice changes in treatment and prevention of thrombotic complications in patients with new COVID-19-infection. Materials/Methods. The work was based on two anonymous surveys conducted in February and August 2021 with the participation of 223 and 131 physicians treating patients with chronic and acute vascular diseases, respectively. The questionnaires included 17 questions describing physicians’ attitudes regarding treatment choices, use of pharmaceuticals, and methods of hemostasis monitoring. Results. The results of the questionnaires revealed a continuing high degree of awareness among the medical community about the increased risk of thrombotic complications in COVID-19 and the need to correct coagulopathy by prescribing adequate anticoagulant therapy (ACT). Low molecular weight heparins (LMWHs) retain the highest degree of confidence among respondents in inpatient ACT, although the number of physicians recommending new oral anticoagulants (NOACs) is increasing, despite the lack of high-quality randomized trials confirming their effectiveness. There has been an increase in respondents’ awareness of issues related to hemostasis laboratory control. Conclusions. The results obtained indicate the need to continue the information campaign regarding the prevention of COVID-19-coagulopathy among healthcare workers.

The realities of the anticoagulant therapy using in COVID-19.

2021 ◽  
Author(s):  
Е.В. Ройтман ◽  
Т.В. Вавилова ◽  
С.М. Маркин ◽  
П.Ф. Кравцов ◽  
К.В. Мазайшвили
Keyword(s):  
Blood Coagulation ◽  
Anticoagulant Therapy ◽  
Clinical Guidelines ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vascular Diseases ◽  
Treatment And Prevention ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Thrombotic Complications

Введение. Поступление вируса SARS-CoV-2 в организм человека сопровождается развитием COVID-19-ассоциированной коагулопатии, часто реализующейся в различных тромботических осложнениях. Актуальные клинические рекомендации описывают основные подходы к лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО), однако реализация их не всегда представляется возможной. В реальной практике встречается значительное количество отклонений и нарушений, в том числе носящих системный характер, связанных как с ограниченностью представлений клиницистов о патогенетических аспектах развития инфекционного процесса, так и с избыточным желанием предотвратить отдельные из них. Цель исследования: изучение состояния реальной клинической практики в области лечения и профилактики развития тромботических осложнений у пациентов c новой коронавирусной инфекцией COVID-19 (НКИ COVID-19). Материалы и методы. В основе работы лежит анонимный опрос 223 врачей-специалистов, занимающихся лечением пациентов с хроническими и острыми заболеваниями сосудов. В опросник включено 18 вопросов, описывающих отношение врачей к проблеме в целом, а также касающихся выбора тактики лечения, применения антикоагулянтных препаратов и методов контроля системы гемостаза. Результаты. Подавляющее большинство участников опроса информированы и озадачены увеличением риска тромботических осложнений при НКИ COVID-19. При этом приоритетной целью антикоагулянтной терапии (АКТ) в острой фазе заболевания участники назвали лечение COVID-19-ассоциированной коагулопатии, а в стадии реконвалесценции — профилактику ВТЭО. Максимальную степень доверия при назначении АКТ имеют низкомолекулярные гепарины. Прямые оральные антикоагулянты, несмотря на отсутствие качественных рандомизированных исследований, подтверждающих их эффективность, большая часть врачей использует на амбулаторном этапе. Вызывает озабоченность значительный разброс вариантов и невысокий процент корректных ответов в вопросах, посвященных лабораторному контролю за системой гемостаза при АКТ. Заключение. Выполненный нами анализ свидетельствует о существенном расхождении реального применения антикоагулянтных препаратов у пациентов с НКИ COVID-19 с действующими клиническими рекомендациями. Кроме того, полученные результаты свидетельствуют о необходимости повышения уровня образованности практикующих специалистов в вопросах свертывания крови. Background. The SARS-CoV-2 virus invasion lead to COVID-19-associated coagulopathy accompanied with increased incidence of thrombotic complications. Current clinical guidelines give the main approaches to the treatment and prevention of them; however their implementation is not always possible in practice. In fact, there are a lot of violations including with a systemic genesis and associated either with the low understanding of infectious process pathogenesis aspects by clinicians or with their excessive desire to prevent coagulation disturbances. the revealing of real clinical practice conditions in the treatment and prevention of thrombotic complications in patients with coronavirus infection COVID-19. Materials/Methods. We provided an anonymous poll for 223 experts treating patients with chronic and acute vascular diseases. The questionnaire included 18 questions to identify as the experts attitude to this challenge as a whole as well as to their choice of treatment tactics, and anticoagulant drugs, and methods of laboratory monitoring of blood coagulation. Results. Most participants know the increased risk of thrombotic complications in COVID-19 and they are puzzled by it The treatment of COVID-19-associated coagulopathy is considered as the priority goal of anticoagulant therapy in the acute phase of COVID-19 whereas the prevention of venous thromboembolic complications is noted as main goal in convalescences. Low molecular weight heparins have gotten the highest confidence in the administration among anticoagulants. In turn, the most of experts use direct oral anticoagulants in outpatients even despite no confirmation is for DOAC’s effectiveness from randomized trials in this time. Besides it was revealed wide spread of opinions and low count of correct responses about laboratory control of the hemostatic system and anticoagulants. Conclusion. The analysis showed a serious inconsistency between the real anticoagulants administration in patients with COVID-19 and the recommendations of clinical guidelines. This circumstance obviates the need to raise educational level of physicians and surgeons in the field of blood coagulation.

scholarly journals A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis

2010 ◽  
Vol 103 (04) ◽  
pp. 749-756 ◽  
Author(s):  
Francesca Cesari ◽  
Rosanna Abbate ◽  
Franco Gensini ◽  
George Broze ◽  
Sandra Fedi ◽  
...  
Keyword(s):  
Pregnancy Complications ◽  
Meta Analysis ◽  
Vascular Diseases ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Protein Z ◽  
Low Protein ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Thrombotic Diseases

SummaryThe relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05–4.12; p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial vascular diseases (OR 2.67, 95%CI 1.60–4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31–7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19–4.00; p=0.01). The results of this meta-analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis, pregnancy complications and venous thromboembolism.

scholarly journals COVID-19-associated coagulopathy: review of current recommendations for diagnosis, treatment and prevention

2020 ◽  
Author(s):  
K. V. Lobastov ◽  
I. V. Schastlivtsev ◽  
O. Ya. Porembskaya ◽  
O. V. Dzenina ◽  
A. B. Bargandzhiya ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Preference ◽  
Thromboembolic Complications ◽  
Treatment And Prevention ◽  
Venous Thromboembolic ◽  
Coronavirus Infection ◽  
Discharge From Hospital ◽  
Therapeutic Doses

The coronavirus infection COVID-19 is a highly contagious disease caused by the SARS-CoV-2 virus. Specific prothrombotic changes of the hemostasis system in COVID-19 are associated with increased incidence of venous thromboembolic complications. The article is a literature review on the diagnosis, treatment and prevention of coagulopathy and venous thromboembolic complications associated with COVID-19. 11 studies evaluating the frequency of registration of venous thromboembolic complications and 11 clinical recommendations on correction of coagulopathy published before May 22, 2020 have been studied. The frequency of venous thromboembolic complications was unexpectedly high: 8-13% in the general ward and 9-18% in the intensive care unit against the background of preventive measures. Preventive doses of anticoagulants, low-molecular weight heparins or unfractionated heparin are indicated to all hospitalized patients. Prolonged prophylaxis after discharge from hospital can be recommended for those at high risk of venous thromboembolic complications and low risk of bleeding. An increase in D-dimer may be considered as an indication for instrumental detection of venous thromboembolic complications. If there is a suspicion of venous thromboembolic complications, anticoagulant therapy at therapeutic doses can be started before the diagnosis is confirmed: during inpatient treatment preference should be given to low-molecular heparin or unfractionated heparin, after discharge from hospital it is recommended to transfer to direct oral anticoagulants for a period of at least 3 months. Routine prevention of venous thromboembolic complications in ambulatory patients is not recommended.

Activation of Blood Coagulation after Abrupt or Stepwise Withdrawal of Oral Anticoagulants - A Prospective Study

1994 ◽  
Vol 72 (02) ◽  
pp. 222-226 ◽  
Author(s):  
G Palareti ◽  
C Legnani ◽  
G Guazzaloca ◽  
M Frascaro ◽  
F Grauso ◽  
...  
Keyword(s):  
Blood Coagulation ◽  
Oral Anticoagulants ◽  
Low Grade ◽  
Abrupt Discontinuation ◽  
Venous Thromboembolic ◽  
Group A ◽  
Thrombotic Complications ◽  
Group B ◽  
A Prospective Study ◽  
Very High

SummaryThe occurrence of a “rebound hypercoagulable state” in patients after discontinuation of oral anticoagulants is still a matter of debate and no definite recommendation can be made on the best procedure for anticoagulant withdrawal. The present study investigated the changes in the levels of markers of activated blood coagulation in 32 patients (pts) in whom warfarin treatment (for venous thromboembolic disease) was randomly withdrawn abruptly (n = 17, group A) or gradually (n = 15, group B: ⅔ of initial dose the 1st week, ⅓ the 2nd weeks and nothing from the 3rd week on). Blood was sampled at baseline, once a week for the first three weeks and after 2 months. At the 1st week group A had significantly higher F1+2 and TAT values (p <0.001); at the 2nd week F1 + 2 levels remained higher (p <0.05) though INR values were not different from those of group B. After baseline, higher than normal F1+2 levels were recorded in 32/66 (48%) controls in group A vs 15/60 (25%) in group B (p <0.01); at the 2nd week, 10/17 (59%) patients in group A vs 1/15 (7%) in group B still had higher than normal F1+2 levels (p <0.01 ). The values of areas under curve (AUC) and maximum concentrations of all variables were not statistically different in the two groups; however, very high levels were observed in a few cases of group A. Thrombotic events (one DVT recurrence and one thrombophlebitis in a varicose vein) occurred in 2 pts of group A, both with high F1+2 and TAT AUC values. In conclusion, the present study shows that withdrawal of oral anticoagulants elicits low grade transient clotting activation, which is more intense and longer lasting after abrupt discontinuation. In single cases, however, such activation is particularly intense. It is possible that these cases are at greater risk of thrombotic complications.

Een ischemische beroerte als presentatie van een occulte maligniteit: typisch beeld op een MRI van de hersenen

2021 ◽  
Author(s):  
H. ENGELS ◽  
M. LEMMERLING ◽  
J. DE BLEECKER
Keyword(s):  
Ischemic Stroke ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
High Signal ◽  
Diffusion Weighted Mri ◽  
Diffusion Weighted ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Occult Malignancy ◽  
Theoretical Considerations

Stroke as the first manifestation of an occult malignancy: typical pattern on a diffusion-weighted MRI An 89-year-old woman was admitted to the emergency department with temporary loss of coordination in her right arm. Diffusion-weighted imaging revealed the ‘three territory sign’ (TTS): multiple high-signal intensities in the territories of both the anterior and posterior circulations. Although a cardioembolic source is often suggested as the cause of multiple ischemic lesions, TTS is frequently seen in patients with a concomitant malignancy. When further investigated, the patient was diagnosed with a pancreatic carcinoma. The ischemic stroke was considered the first manifestation of the carcinoma, as conventional causes were excluded. Patients with a malignancy have an increased risk of an ischemic stroke. A potential explanation for this phenomenon is cancer-associated hypercoagulability. The treatment of cancer-associated hypercoagulability remains a challenge for clinicians. By analogy with the therapy for venous thromboembolic disorders in cancer patients, low-molecular-weight heparins (LMWH) could also be used safely and effectively for cancer-associated ischemic stroke. In different studies, variable results are observed with direct oral anticoagulants (DOACs) in the treatment of cancer-associated ischemic stroke. Despite the strong theoretical considerations, no clear benefit has been demonstrated for the use of anticoagulant versus antiplatelet therapy in this population. Further prospective research is needed.

Heparins and Venous Thromboembolism: Current Practice and Future Directions

2001 ◽  
Vol 86 (07) ◽  
pp. 488-498 ◽  
Author(s):  
Paolo Prandoni
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Outpatient Setting ◽  
Vein Thrombosis ◽  
Treatment And Prevention ◽  
Major Orthopedic Surgery ◽  
Venous Thromboembolic ◽  
Reduction Of Mortality ◽  
Deep Vein

SummaryUnfractionated heparin (UFH) in adjusted doses and low-molecularweight heparins (LMWH) in fixed doses are the chosen therapy for the initial treatment of venous thromboembolism. The use of UFH protocols ensures that virtually all patients will promptly achieve the therapeutic range for the activated partial thromboplastin time. However, proper use of UFH requires considerable expertise, can cause inconvenience and has limitations. Unmonitored therapy with subcutaneous LMWH is at least as effective and safe as adjusted-dose UFH, is associated with a considerable reduction of mortality in cancer patients, and permits the treatment of suitable patients in an outpatient setting.LMWH in high prophylactic doses is more effective than UFH and oral anticoagulants for prevention of postoperative venous thrombosis in major orthopedic surgery. Whether thromboprophylaxis should be continued for a few additional weeks after hospital discharge is controversial. LMWH and UFH are equally effective for prevention of postoperative deep-vein thrombosis in cancer patients. In a recent controlled randomized trial, enoxaparin in high prophylactic doses was an effective and safe measure of thromboprophylaxis in ordinary bedridden patients.The efficacy and safety of pentasaccharide (the smallest antithrombin binding sequence of heparin) in the treatment and prevention of venous thromboembolic disorders is currently under investigation.

scholarly journals Bleeding and thrombotic complications during treatment with direct oral anticoagulants or vitamin K antagonists in venous thromboembolic patients included in the prospective, observational START2-register

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040449
Author(s):  
Gualtiero Palareti ◽  
Emilia Antonucci ◽  
Cristina Legnani ◽  
Daniela Mastroiacovo ◽  
Daniela Poli ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Efficacy Rate ◽  
Bleeding Events ◽  
Venous Thromboembolic ◽  
Thrombotic Complications ◽  
The Difference

ObjectiveThe proportion and characteristics of Italian patients affected by venous thromboembolism (VTE) treated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), and complications occurring during follow-up.DesignA prospective cohort of 2728 VTE patients included in the Survey on anticoagulaTed pAtients RegisTer (START2-Register) from January 2014 to June 2018 was investigated. Characteristics of patients, type of treatment and complications occurring during 2962 years of follow-up were analysed.SettingAbout 60 Italian anticoagulation and thrombosis centres participated in the observational START2-RegisterParticipants2728 adult patients with VTE of a lower limb and/or pulmonary embolism (PE), with a follow-up after the initial phase treatment.InterventionsPatients could receive DOACs or VKAs; both prescribed by the National and Regional Health Systems for patients with VTE.Outcomes measuresEfficacy: rate of VTE recurrence (all thrombotic complications were also recorded). Safety: the rate of major and clinically relevant non-major bleeding events.ResultsAlmost 80% of patients were treated with DOACs. The prevalence of symptomatic PE and impaired renal function was higher in patients receiving VKAs. Duration of anticoagulation was >180 days in approximately 70% of patients. Bleeding events were similar in both treatment groups. The overall eventuality of recurrence was significantly higher in DOAC cohorts versus VKA cohorts (HR 2.15 (1.14–4.06), p=0.018); the difference was almost completely due to recurrences occurring during extended treatment (2.73% DOAC vs 0.49% VKA, p<0.0001). All-cause mortality was higher in VKA-treated (5.9%) than in DOAC-treated patients (2.6%, p<0.001).ConclusionItalian centres treat most patients with VTE with DOACs and prefer VKA for those with more serious clinical conditions. Recurrences were significantly more frequent in DOAC-treated patients due to increased incidence after 180 days of treatment, probably due to reduced adherence to treatment. These results underline the importance of structured surveillance of DOAC-treated patients with VTE to strengthen treatment adherence during extended therapy.

scholarly journals Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms

2020 ◽  
Author(s):  
Karlo Huenerbein ◽  
Parvis Sadjadian ◽  
Tatjana Becker ◽  
Vera Kolatzki ◽  
Eva Deventer ◽  
...  
Keyword(s):  
Myeloproliferative Neoplasms ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Thromboembolic Events ◽  
Number Of Patients ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

AbstractIn patients with BCR-ABL-negative myeloproliferative neoplasms (MPN), arterial or venous thromboembolic events (ATE/VTE) are a major burden. In order to control these complications, vitamin K antagonists (VKA) are widely used. There is no robust evidence supporting the use of direct oral anticoagulants (DOAC) in MPN patients. We therefore compared the efficacy and safety of both anticoagulants in 71 cases from a cohort of 782 MPN patients. Seventy-one of 782 MPN patients (9.1%) had ATE/VTE with nine ATE (12.7%) and 62 VTE (87.3%). Forty-five of 71 ATE/VTE (63.4%) were treated with VKA and 26 (36.6%) with DOAC. The duration of anticoagulation therapy (p = 0.984), the number of patients receiving additional aspirin (p = 1.0), and the proportion of patients receiving cytoreductive therapy (p = 0.807) did not differ significantly between the VKA and DOAC groups. During anticoagulation therapy, significantly more relapses occurred under VKA (n = 16) compared to DOAC treatment (n = 0, p = 0.0003). However, during the entire observation period of median 3.2 years (0.1–20.4), ATE/VTE relapse-free survival (p = 0.2) did not differ significantly between the two anticoagulants. For all bleeding events (p = 0.516) or major bleeding (p = 1.0), no significant differences were observed between VKA and DOAC. In our experience, the use of DOAC was as effective and safe as VKA, possibly even potentially beneficial with a lower number of recurrences and no increased risk for bleedings. However, further and larger studies are required before DOAC can be routinely used in MPN patients.

scholarly journals Viral Coagulopathy in Patients With COVID-19: Treatment and Care

2020 ◽  
Vol 26 ◽  
pp. 107602962093677 ◽  
Author(s):  
Nickolas Kipshidze ◽  
George Dangas ◽  
Christopher J. White ◽  
Nodar Kipshidze ◽  
Fakiha Siddiqui ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Endothelial Damage ◽  
Cellular Mechanisms ◽  
Catheter Directed Thrombolysis ◽  
Organ Systems ◽  
Thrombotic Complications ◽  
Novel Coronavirus

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.

scholarly journals Emerging Treatment and Prevention Strategies against COVID-19: A Brief Update

2020 ◽  
Vol 11 (01) ◽  
pp. 69-72
Author(s):  
Ashish K. Jha ◽  
Ravikant Kumar ◽  
Mahesh K. Goenka ◽  
Vishwa M. Dayal
Keyword(s):  
Septic Shock ◽  
Sufficient Evidence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
Treatment And Prevention ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Life Threatening ◽  
Novel Coronavirus

AbstractPatients with novel coronavirus disease 2019 (COVID-19) are at significantly increased risk for mortality and morbidity. Current management remains supportive care, ranging from symptomatic outpatient management to full–intensive care support, including intravenous fluids, invasive, and non-invasive oxygen supplementation. In patients with septic shock, treatment with antibiotics and vasopressors are recommended to keep mean arterial pressure (MAP) ≥ 65 mm Hg and lactate < 2 mmol/L. Because of the lack of effectiveness and possible adverse effects, routine corticosteroids should be avoided unless they are indicated for another reason (exacerbation of asthma or chronic obstructive pulmonary disease [COPD], and septic shock in whom fluids and vasopressors do not restore hemodynamic stability). There is currently no sufficient evidence of efficacy of hydroxychloroquine/chloroquine, remdesivir, and other antivirals in the treatment or prevention of COVID-19. Limited evidence shows that COVID-19 convalescent plasma can be used as a treatment of COVID-19 without the occurrence of severe adverse events. Drug regulatory agencies granted an emergency-use authorization of chloroquine/hydroxychloroquine and remdesivir to treat patients when a clinical trial is not available or participation is not feasible. Chloroquine and hydroxychloroquine are associated with QT interval prolongation and life-threatening cardiac arrhythmia in patients with pre-existing cardiovascular disease. Guidelines are issued for use of convalescent plasma in patients with serious or immediately life-threatening COVID-19. Data from several ongoing randomized controlled trials will provide further evidence regarding the safety and efficacy of these drugs for the treatment of COVID-19.

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