key: cord-349840-xs2chzmn
authors: Sharma, Varun Kumar; Tomar, Lomas Kumar; Tyagi, Charu; Manjhi, Jayanad; Reddy, Yugandhar P.; Tiwari, Santosh Kumar
title: COVID-19 and Anticoagulant based therapeutics: an approach with great promise
date: 2020-10-07
journal: J Infect Public Health
DOI: 10.1016/j.jiph.2020.09.014
sha: 
doc_id: 349840
cord_uid: xs2chzmn

nan

Coronavirus disease 2019 (COVID-19, also known as Severe Acute Respiratory Syndrome Coronavirus 2) has been reported as a novel outbreak since December 2019, and had become pandemic. consists of a single standard RNA which primarily enters the host cell by binding the angiotensinconverting enzyme 2 protein, abundantly expressed in the lung alveolar cells. This suggests that respiratory system is the primary target during the COVID-19 infection (Zhang et al., 2020) . Although, COVID-19 is not just a respiratory disease, but has been identified in some patient to mimic coagulopathy conditions such as, thrombosis and disseminated intravascular coagulation (DIC). Outcome based clinical observation revealed that about 46% patients with COVID-19 (globally) suffered coagulopathy condition and elevated levels of D-dimer (>0.5 mg/L) (Levi et al., 2020 , Guan et al., 2020 . Additionally, COVID-19 infected patients have higher risk of thrombotic disease including acute coronary syndrome, venous thromboembolism or pulmonary embolism, or stroke and increase risk of mortality (Watson et al., 2020) .

Furthermore, an elevated D-dimer expression and extended prothrombin time have been observed and is significantly associated with poor prognosis in COVID-19 infected patients. D-dimer could be consider as a potent biomarker of fibrin formation and degradation and also can be used as a risk stratification marker in case of COVID-19 infection (Kollias et al., 2020) .

Furthermore, COVID-19 infection is highly critical in those patients who is already predisposed to thrombotic disease or are under the process of antithrombotic treatment (Bikdeli et al., 2020) . Therefore, it has been assumed that suppressed coagulopathy based approach using anticoagulant could be one of the best options to improve the therapeutic possibilities to control COVID-19 pathogenesis and support the quality of life of patients. Anticoagulants such as lopinavir/ritonavir or their combination with Vitamin K antagonists (apixaban, and betrixaban) could be administered orally (Figure 1 ). Anticoagulant therapy, mainly with low molecular weight heparin boost the survival rate of COVID-19 infected patients with coagulopathy (Tang et al., 2020) . Additionally, a case series reported by Zhang et. Al, suggests that coagulopathy in COVID-19 infected patients is associated with antiphospholipid antibodies which include anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) (Zhang et al., 2020) .

Figure 1: Anticoagulant based therapeutic could add health benefit to COVID-19 patients via suppressing coagulopathy. Anticoagulant based treatments benefit to the patients suffering from thrombotic and hemorrhagic pathological condition via suppressing the coagulation factors, such as vitamin K antagonists (apixaban, and betrixaban) or anti-heparin or other anticoagulant. Coagulopathy is a most prevalent physiological condition that have been observed in COVID-19 infected patients and is a one of the major causes of mortality around the world. As there are no any specific medication or vaccination strategies evolved to control the COVID-19 infection, the anticoagulant based therapy could be helpful to reduce coagulopathy event and could provide a better therapeutic approach against COVID-19 pathogenesis.

J o u r n a l P r e -p r o o f

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

Clinical Characteristics of Coronavirus Disease 2019 in China

Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action

Coagulation abnormalities and thrombosis in patients with COVID-19

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Anti-Coagulant and Anti-Platelet Therapy in the COVID-19 Patient: A Best Practices Quality Initiative Across a Large Health System

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid

Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target