Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence

Int J Cardiol. 2021 Feb 1:324:261-266. doi: 10.1016/j.ijcard.2020.09.064. Epub 2020 Sep 28.

Abstract

In patients with severe or critical Coronavirus disease 2019 (COVID-19) manifestations, a thromboinflammatory syndrome, with diffuse microvascular thrombosis, is increasingly evident as the final step of pro-inflammatory cytokines storm. Actually, no proven effective therapies for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exist. Preliminary observations on anticoagulant therapy appear to be associated with better outcomes in moderate and severe COVID-19 patients with signs of coagulopathy and in those requiring mechanical ventilation. The pathophysiology underlying the prothrombotic state elicited by SARS-CoV-2 outlines possible protective mechanisms of antithrombotic therapy (in primis anticoagulants) for this viral illness. The indications for antiplatelet/anticoagulant use (prevention, prophylaxis, therapy) are guided by the clinical context and the COVID-19 severity. We provide a practical approach on antithrombotic therapy management for COVID-19 patients from a multidisciplinary point of view.

Keywords: Anticoagulants; Antiplatelet; Antithrombotic therapy; COVID-19; Coronavirus; Thromboinflammatory syndrome.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • COVID-19 / blood*
  • COVID-19 / physiopathology
  • COVID-19 Drug Treatment*
  • Evidence-Based Medicine / trends*
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Thrombosis / blood
  • Thrombosis / drug therapy
  • Thrombosis / physiopathology

Substances

  • Anticoagulants
  • Fibrinolytic Agents