Procoagulant activity during viral infections

Scharrer, I.

doi:10.2741/4633

Cited by 83 publications

(47 citation statements)

References 142 publications

(168 reference statements)

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“…Acute infections, including viral ones, induce a systemic inflammatory response and coagulation disruption (Subramaniam and Scharrer, 2018). The process is complex and multifactorial, involving cellular disruption and plasmatic elements of the hemostatic system and of the innate immune system to the pathogen (Gando et al, 2016).…”

Section: Inflammation Sepsis and Coagulopathymentioning

confidence: 99%

The Potential Role of Heparin in Patients With COVID-19: Beyond the Anticoagulant Effect. A Review

et al. 2020

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is responsible of variable clinical manifestations, ranging from no symptoms to severe pneumonia with acute respiratory distress syndrome, septic shock, and multi-organ failure resulting in death. To date no specific antiviral drug have been approved for COVID-19, so the treatment of the disease is mainly focused on symptomatic treatment and supportive care. Moreover, there are no treatments of proven efficacy to reduce the progression of the disease from mild/moderate to severe/critical. An activation of the coagulation cascade leading to severe hypercoagulability has been detected in these patients, therefore early anticoagulation may reduce coagulopathy, microthrombus formation, and the risk of organ damages. The role of heparin in COVID-19 is supported by a lot of studies describing its pleiotropic activity but it must be proven in clinical trials. Several protocols have been designed to assess the risk-benefit profile of heparin (low-molecularweight or unfractionated heparin) in hospitalized subjects. Although prophylactic doses may be adequate in most patients, it is important to wait the results of clinical trials in order to define the appropriate effective dose able to improve disease outcome.

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Section: Inflammation Sepsis and Coagulopathymentioning

confidence: 99%

The Potential Role of Heparin in Patients With COVID-19: Beyond the Anticoagulant Effect. A Review

et al. 2020

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“…Thromboelastography showing a pattern of hypercoagulability despite the use of heparin during the course of viral diseases has been previously reported (Wilson et al, 2016). In fact, many viruses known to induce a state of hypercoagulability (Subramaniam and Scharrer, 2018) have a similar pattern of disease, including the timeframe of FIGURE 1 | PO 2 /FiO 2 ratio over time from start of anticoagulation. (A) All patients included; (B) Patients with WHO score ≥4 at hospital admission (WHO Score: ordinal scale for clinical improvement proposed by the World Health Organization: 0.…”

Section: Discussionmentioning

confidence: 82%

Heparin Therapy Improving Hypoxia in COVID-19 Patients – A Case Series

et al. 2020

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Introduction: Elevated D-dimer is a predictor of severity and mortality in COVID-19 patients, and heparin use during in-hospital stay has been associated with decreased mortality. COVID-19 patient autopsies have revealed thrombi in the microvasculature, suggesting that hypercoagulability is a prominent feature of organ failure in these patients. Interestingly, in COVID-19, pulmonary compliance is preserved despite severe hypoxemia corroborating the hypothesis that perfusion mismatch may play a significant role in the development of respiratory failure. Methods: We describe a series of 27 consecutive COVID-19 patients admitted to Sirio-Libanes Hospital in São Paulo-Brazil and treated with heparin in therapeutic doses tailored to clinical severity. Results: PaO2/FiO2 ratio increased significantly over the 72 h following the start of anticoagulation, from 254(±90) to 325(±80), p = 0.013, and 92% of the patients were discharged home within a median time of 11 days. There were no bleeding complications or fatal events. Discussion: Even though this uncontrolled case series does not offer absolute proof that micro thrombosis in the pulmonary circulation is the underlying mechanism of respiratory failure in COVID-19, patient's positive response to heparinization contributes to the understanding of the pathophysiological mechanism of the disease and provides valuable information for the treatment of these patients while we await the results of further prospective controlled studies.

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“…Preliminary literature has suggested disseminated intravascular coagulation (DIC) as a possible mechanism, as thrombocytopenia and elevated Ddimer has have been found at higher rates in COVID-19 infected patients. Endothelial dysfunction [7], upregulation of procoagulant genes, and Toll-like receptor activation [8] are also hypothesized to occur.…”

Section: Discussionmentioning

confidence: 99%

To Anticoagulate or Not: Acute Stroke in a COVID-19 Patient With Gastrointestinal Bleed

George¹,

Kirkland²,

Lattanzio³

et al. 2020

Cureus

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family, which comprises enveloped positive sense ribonucleic acid (RNA) viruses responsible for pandemic outbreaks including Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV), and most recently coronavirus disease 2019 (COVID-19). A 30-year-old previously healthy male diagnosed 11 days earlier with COVID-19 presented with right-sided weakness and dysarthria. The patient was found to have an acute left carotid thrombus with embolic multifocal infarcts throughout the left cerebral hemisphere. He was treated acutely with intravenous heparin however developed gastrointestinal bleeding, prompting discontinuation of anticoagulation. Follow up CT angiography 12 days following his stroke demonstrated complete resolution of the thrombus. Since discharge, the patient has been managed with antiplatelet therapy alone with complete neurologic recovery. Large vessel strokes amongst young patients have been a growing concern during the SARS-CoV-2 outbreak. The use of acute therapeutic and prophylactic anticoagulation is based on risk assessment. Albeit, the utility of anticoagulation in COVID-19 patients remains undetermined. Prevention of stroke recurrence is a clinical priority for providers treating large vessel stroke patients. More research is required to establish the effectiveness of anticoagulation and antiplatelet therapy for stroke prevention in patients diagnosed with COVID-19.

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Procoagulant activity during viral infections

Cited by 83 publications

References 142 publications

The Potential Role of Heparin in Patients With COVID-19: Beyond the Anticoagulant Effect. A Review

The Potential Role of Heparin in Patients With COVID-19: Beyond the Anticoagulant Effect. A Review

Heparin Therapy Improving Hypoxia in COVID-19 Patients – A Case Series

To Anticoagulate or Not: Acute Stroke in a COVID-19 Patient With Gastrointestinal Bleed

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