key: cord-0797557-twirs6mz
authors: Assinger, Alice
title: COVID‐19–related prothrombotic changes increase with lung injury and remain unaffected by anticoagulation therapy
date: 2021-01-04
journal: Res Pract Thromb Haemost
DOI: 10.1002/rth2.12473
sha: 4f889f699a5b372744eb16bd6e701cda7d9b2f07
doc_id: 797557
cord_uid: twirs6mz

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However, there is a gap in understanding the underlying cause of CAC and its precise mechanism. Neither do we know why some patients are more prone to CAC compared to others and how adverse events should be treated and prevented. to vascular leakage and inflammation, has been shown to be elevated in patients with COVID-19. 6 LMWH is an inhibitor of heparanase and could therefore bear beneficial effects by preventing glycocalyx degradation. 6 Moreover, heparin was recently found to bind SARS-CoV-2 with high affinity, thereby inhibiting virus binding on angiotensin-converting enzyme 2-expressing cells in vitro. 7 There are multiple inflammatory and pathogenic mechanisms targeted by heparin 8 ; therefore, it is warranted to conduct clinical studies that evaluate therapeutic doses of these compounds in patients with COVID-19.

In clear contrast, little is known on the pathomechanistic effects of DOACs on COVID-19 disease progression to this date, while an improvement in survival was seen for patients treated with DOACs.

Importantly, alternatives to current therapeutic strategies need to be evaluated in the near future. Neutrophils, immunogenic platelets, and a dysregulated coagulation cascade cooperate to propagate immunothrombotic tissue injury in COVID-19, revealing that immunothrombosis is not just a bystander in COVID-19 but rather a link between systemic hypercoagulability and respiratory failure. 9 

COVID-19: a single health system study

Increased plasma heparanase activity in COVID-19 patients

Sulfated polysaccharides effectively inhibit SARS-CoV-2 in vitro

Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

Immunothrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy

cardiovascular disease: an expert consensus document from the Third Maastricht Consensus Conference on Thrombosis

International Network of VTCRNI-VTE. Anticoagulant interventions in hospitalized patients with COVID-19: a scoping review of randomized controlled trials and call for international collaboration