Potential clinical applications of phytopharmaceuticals for the in‐patient management of coagulopathies in COVID‐19

Abstract

Thrombotic complications occur in many cardiovascular pathologies and have been demonstrated in COVID‐19. The currently used antithrombotic drugs are not free of adverse reactions, and COVID‐19 patients in particular, when treated with a therapeutic dose of an anticoagulant do not receive mortality benefits. The clinical management of COVID‐19 is one of the most difficult tasks for clinicians, and the search for safe, potent, and effective antithrombotic drugs may benefit from exploring naturally bioactive molecules from plant sources. This review describes recent advances in understanding the antithrombotic potential of herbal drug prototypes and points to their future clinical use as potent antithrombotic drugs. Although natural products are perceived to be safe, their clinical and therapeutic applications are not always apparent or accepted. More in‐depth studies are necessary to demonstrate the clinical usefulness of plant‐derived, bioactive compounds. In addition, holistic approaches in systematic investigations and the identification of antithrombotic mechanisms of the herbal bioactive molecule(s) need to be conducted in pre‐clinical studies. Moreover, rigorous studies are needed to compare the potency of herbal drugs to that of competitor chemical antithrombotic drugs, and to examine their interactions with Western antithrombotic medicines. We have also proposed a road map to improve the commercialization of phytopharmaceuticals.

Therapeutic effects and molecular mechanisms of natural products in thrombosis

“…For formed thrombus, thrombolytics are often preferentially given to activate fibrinogen to promote fibrinolysis (Mackman, 2008). Despite the abundance of clinical antithrombotic strategies, the risk of bleeding and the high recurrence rate are always unavoidable (Mukherjee & Chattopadhyay, 2022). A large number of preclinical studies have demonstrated the potential of natural products in thrombosis therapy (Figure 5), some of which are derived from herbs used in the treatment of cardiovascular diseases, and the elucidation of the antithrombotic activity and mechanisms of these monomers has also provided evidence for the clinical application of herbs.…”

“…Similarly, patients with stroke or myocardial infarction have 1.3 times the risk of developing a venous thrombosis than the normal population (SØRensen et al, 2009). However, the combination of antiplatelets and anticoagulants does not seem to be a perfect solution, which can lead to serious complications (Mukherjee & Chattopadhyay, 2022). Therefore, the development of safer antithrombotic drugs and the establishment of more scientific dosing guidelines are necessary for thrombosis treatment.…”

“…Although these drugs have shown favorable antithrombotic effects, some unavoidable side effects have also been observed. For example, some drugs such as heparin, urokinase, and streptokinase may increase the risk of bleeding (Li, Guo, et al, 2022; Polla et al, 2004); even if patients receive antithrombotic drugs, it does not reduce the rate of recurrence and mortality (Mukherjee & Chattopadhyay, 2022); drug‐interaction between antiplatelets and anticoagulants can lead to serious complications for patients (Mukherjee & Chattopadhyay, 2022). Therefore, it is necessary to develop safer and more effective antithrombotic drugs.…”

Phytomedicine for neurodegenerative diseases: The road ahead

“…These traditional products have neuroprotective potency due to their antioxidant, anti‐inflammatory, neurotrophic, anti‐apoptotic, and acetylcholinesterase inhibiting activities (Mohd Sairazi & Sirajudeen, 2020). According to the WHO, more than 80% of the global population depends on herbal remedies to treat their health issues; however, most plant products have not yet been scientifically verified (Mukherjee & Chattopadhyay, 2022). A remarkable shift is in drug discovery from synthetic to natural formulations is currently underway (Solayman et al, 2017).…”

“…Plants are the treasure house of primary and secondary metabolites, which are reported to have different therapeutic applications (Mukherjee & Chattopadhyay, 2022). Based on preclinical studies, numerous plants and their phytochemicals have been identified as promising drug therapies for NDs, but their pre-clinical and clinical verifications are still pending (Mohd Sairazi & Sirajudeen, 2020).…”