Erschienen in:
15.07.2020 | Review Article
Coagulopathy and thromboembolic events in patients with
SARS-CoV-2 infection: pathogenesis and management strategies
verfasst von:
Alessandro Allegra, Vanessa Innao, Andrea Gaetano Allegra, Caterina Musolino
Erschienen in:
Annals of Hematology
|
Ausgabe 9/2020
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Abstract
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.