Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19

Martinelli, Ida; Ciavarella, Alessandro; Abbattista, Maria; Aliberti, Stefano; Zan, Valentina De; Folli, Christian; Panigada, Mauro; Gori, Andrea; Artoni, Andrea; Ierardi, Anna Maria; Carrafiello, Gianpaolo; Monzani, Valter; Grasselli, Giacomo; Blasi, Francesco; Peyvandi, Flora

doi:10.1007/s11739-020-02585-9

Cited by 36 publications

(44 citation statements)

References 23 publications

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“…However, 3% of patients on high doses of enoxaparin experienced nonfatal major bleeding. [ 42 ] Coagulopathy represents one of the most important determinants of morbidity and mortality in coronavirus-19 disease (COVID-19). Another retrospective study was conducted in a sample of 105 hospitalized patients treated with subcutaneous enoxaparin: 80 mg/day in patients with normal weight and mild to moderate impairment or normal renal function; 40 mg/day in severe chronic renal failure or low body weight (< 45 kg); 100 mg/day if body weight was greater than 100 kg.…”

Section: Discussionmentioning

confidence: 99%

Low Molecular Weight Heparin, Anti-inflammatory/Immunoregulatory and Antiviral Effects, a Short Update

Vitiello

Ferrara²

2021

Cardiovasc Drugs Ther

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Low molecular weight heparin (LMWH) is a glycosaminoglycan long known for its anticoagulant properties. In recent times, recent evidence has associated this drug with extra pleiotropic anticoagulant effects that have also proven useful in the management of the treatment of COVID-19 infection indicating that heparin may play other roles in the management of the disease in addition to the prevention of thrombosis. Clinical observations and in vitro studies support that heparin has a potential multi-target effect. To date, the molecular mechanisms of these pleiotropic effects are not fully understood. This brief review presents some of the evidence from clinical and animal studies and describes the potential molecular mechanisms by which heparin may exert its anti-inflammatory/immunoregulatory and antiviral effects.

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Section: Discussionmentioning

confidence: 99%

Low Molecular Weight Heparin, Anti-inflammatory/Immunoregulatory and Antiviral Effects, a Short Update

Vitiello

Ferrara²

2021

Cardiovasc Drugs Ther

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“…[42,43] Intravascular coagulation and microthrombi formation Lead to increased wasted ventilation and less efficient carbon dioxide removal. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] Diffuse alveolar damage (DAD) Lead to hypoxia at the edematous alveoli.…”

Section: Pathogenic Mechanismsmentioning

confidence: 99%

“…Aspirin administration had an association with less mechanical ventilation and reduced ICU cases, but showed no apparent association with the fatality rate (Table 2) [51]. The therapeutic effects of low molecular weight heparin have also been investigated comprehensively [52][53][54][55][56][57][58]. Heparin may reduce the risk of in-hospital mortality and decrease the occurrence of severe cases.…”

Section: Ventilation-perfusion Mismatch and Intravascular Coagulation In Covid-19mentioning

confidence: 99%

“…Heparin may reduce the risk of in-hospital mortality and decrease the occurrence of severe cases. However, critically-ill COVID-19 patients still had high incidences of venous thromboembolism and worse outcomes, despite the heparin administration at the prophylactic dosage [52][53][54][55][56][57][58]. Moreover, besides its anticoagulation effect, heparin relieves the symptoms through complex mechanisms.…”

Section: Ventilation-perfusion Mismatch and Intravascular Coagulation In Covid-19mentioning

confidence: 99%

“…In summary, initial anticoagulant treatments with low-molecular-weight heparin or aspirin may reduce mortality and achieve a significant improvement in P a O 2 :F i O 2 in some patients but however could not completely prevent occurrence of severe cases [49][50][51][52][53][54][55][56][57][58].…”

Section: Ventilation-perfusion Mismatch and Intravascular Coagulation In Covid-19mentioning

confidence: 99%

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The Role of Alveolar Edema in COVID-19

Yuan

Jiang

Zhang

et al. 2021

Cells

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The coronavirus disease 2019 (COVID-19) has spread over the world for more than one year. COVID-19 often develops life-threateninghypoxemia. Endothelial injury caused by the viral infection leads to intravascular coagulation and ventilation–perfusion mismatch. However, besides above pathogenic mechanisms, the role of alveolar edema in the disease progression has not been discussed comprehensively. Since the exudation of pulmonary edema fluid was extremely serious in COVID-19 patients, we bring out a hypothesis that severity of alveolar edema may determine the size of poorly-ventilated area and the blood oxygen content. Treatments to pulmonary edema (conservative fluid management, exogenous surfactant replacementsand ethanol–oxygen vapor therapyhypothetically) may be greatly helpful for reducingthe occurrences of severe cases. Given that late mechanical ventilation may causemucus (edema fluid) to be blown deep intothe small airways,oxygentherapy should be given at the early stages. Theoptimaltimeand blood oxygen saturation (SpO2) thresholdforoxygentherapy are also discussed.

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