An Ounce of Prevention May Prevent Hospitalization

Abstract

A. Barker has no conflicts of interest, financial or otherwise. B. Wagener has an ongoing collaboration with Sadis Matalon (co-author of the primary review) and has published a paper with him within the last 3 yr. Furthermore, B. Wagener is a co-investigator on both the outpatient and inpatient tranexamic acid studies mentioned in the letter. Editor S. Matalon was not involved in the peer review process of this manuscript.

Potential mechanisms of nafamostat therapy for severe COVID-19 pneumonia with disseminated intravascular coagulation

“…It is true that, because tranexamic acid is known as a strong antifibrinolytic agent that suppresses plasmin production, it is also expected to prevent mild cases of COVID-19 ( Barker and Wagener, 2020 ). However, nafamostat, an antiplasmin agonist that also has antithrombin activity, is much safer in ordinary clinical practice than tranexamic acid, which has the adverse effect of fatal thrombosis ( Ogawa and Asakura, 2020 ).…”

COVID-19-associated coagulopathy and disseminated intravascular coagulation

“…Tranexamic acid is known as a drug exerting strong antiplasmin (antifibrinolytic) activity. Tranexamic acid may act suppressively on SARS-CoV-2 in terms of antiplasmin, and actual clinical trials are underway [ 82 ]. However, tranexamic acid may induce fatal thrombosis and should not be administered without caution [ 83 ].…”

Anti-protease Treatments Targeting Plasmin(ogen) and Neutrophil Elastase May Be Beneficial in Fighting COVID-19

“…In view of this, the more specific type of approach proposed by Ji et al (6), such as targeting plasmin(ogen), may be beneficial. Likewise, tranexamic acid, a synthetic analog that binds lysine receptor sites on plasminogen and prevents its conversion to plasmin, may have therapeutic potential (2,11). It should be noted that a clinical study is currently ongoing which evaluates the efficacy of tranexamic acid, along with the administration of an anticoagulant, in decreasing the severity of the disease (12).…”