Rationale for the Role of Heparin and Related GAG Antithrombotics in COVID-19 Infection

Abstract

The SARS-CoV-2 pandemic has focused attention on prevention, restriction and treatment methods that are acceptable worldwide. This means that they should be simple and inexpensive. This review examines the possible role of glycosaminoglycan (GAG) antithrombotics in the treatment of COVID-19. The pathophysiology of this disease reveals a complex interplay between the hemostatic and immune systems that can be readily disrupted by SARS-CoV-2. Some of the GAG antithrombotics also possess immune-modulatory actions and since they are relatively inexpensive they could play an important role in the management of COVID-19 and its complications.

COVID-19 adenovirus vaccine triggers antibodies against PF4 complexes to activate complement and platelets

“…All our patients met the diagnostic criteria of VITT [4] . Their anticoagulation was acutely managed with danaparoid, a drug recommended for HIT patients [23] . With the exception of patient 4, IVIG treatment was administered to all patients.…”

Experience of danaparoid to treat vaccine-induced immune thrombocytopenia and thrombosis, VITT

“…Unlike other agents, danaparoid is capable to detach PF4 from the platelet surface and disrupt PF4 containing immune complexes [10]. Hence theoretically, danaparoid should have a direct influence on VITT pathogenesis beyond its anticoagulant action [10,13]. Our local guidance for initial anticoagulation during the acute treatment of HIT includes danaparoid, administered either intravenously (loading bolus 1250-3750 U with subsequent tapered infusion till 150-200 U / h) or subcutaneously at doses of 750-1500 U, 2-3 times a day with targeted anti-FXa activity of 0.3-0.5 U / mL [14].…”

“…The median plasma anti-FXa activity was in the lower part of the therapeutic range and during the first week of danaparoid administration clinical symptoms, platelet counts, and fibrin turnover resolved or significantly improved. The average duration of hospital admission was 10 days [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. One patient died but the other five patients recovered completely.…”

A Case Report of a Patient on Therapeutic Warfarin Who Died of COVID-19 Infection with a Sudden Rise in D-Dimer

“…There is more than ample existing evidence on the use of heparin and related derivatives, including fractionated heparin, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs), to prevent or treat thrombotic complications in moderate to severe COVID-19 cases. This therapy balances the drug-drug interaction and individual risk of thrombosis versus bleeding [14,15].…”