Anticoagulant therapy in COVID‐19: A narrative review

Abstract

Coronavirus disease 2019 (COVID‐19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), can manifest itself in several ways, including coagulopathy and thrombosis. These complications can be the first and sometimes only manifestations of SARS‐CoV‐2 infection and can occur early or late in the course of the disease. However, these symptoms are more prevalent in hospitalized patients with venous thromboembolism, particularly those admitted to intensive care units. Moreover, various forms of arterial and venous thrombosis, or micro‐ or macro‐vasculature embolisms, have been reported during the current pandemic. They have led to harmful consequences, such as neurological and cardiac events, nearly all resulting from the hypercoagulable state caused by this viral infection. The severe hypercoagulability observed in patients with COVID‐19 accounts for most cases of the disease that become critical. Therefore, anticoagulants seem to be one of the most vital therapeutics for treating this potentially life‐threatening condition. In the current paper, we present a thorough review of the pathophysiology of COVID‐19‐induced hypercoagulable state and the use of anticoagulants to treat SARS‐CoV‐2 infections in different patient groups, as well as their pros and cons.

Factor Xa inhibitors versus low molecular weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta analysis of randomized controlled trials

“…Patients with COVID-19 may benefit from receiving prophylactic doses of anticoagulant therapy. Historically, the utilization of anticoagulants, primarily heparin, has been shown to decrease overall mortality in COVID-19 patients while they are admitted to the hospital 21 . Contrary to preventative anticoagulation, administering therapeutic anticoagulation to COVID-19 patients who are hospitalized not only did not lead to a decrease in mortality during their hospital stay but also raised the likelihood of experiencing significant bleeding.…”

The Role of Platelet Molecules in Risk Stratification of Patients with COVID-19

“…And although to date there is no consensus on the ideal medication, start, duration and dosage of treatment [174,177,179], detailed study of these molecules would help in understanding the pathophysiology of the disease and could help expand therapeutic options. The markers discussed here suggest possible therapeutic targets for the treatment and thromboprophylaxis of patients hospitalized with COVID-19 and perhaps for other viral infections.…”