Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb 1:324:261-266.
doi: 10.1016/j.ijcard.2020.09.064. Epub 2020 Sep 28.

Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence

Cosmo Godino  1 , Andrea Scotti  2 , Norma Maugeri  3 , Nicasio Mancini  4 , Evgeny Fominskiy  5 , Alberto Margonato  6 , Giovanni Landoni  7
Affiliations
Review

Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence

Cosmo Godino et al. Int J Cardiol. .

Abstract

In patients with severe or critical Coronavirus disease 2019 (COVID-19) manifestations, a thromboinflammatory syndrome, with diffuse microvascular thrombosis, is increasingly evident as the final step of pro-inflammatory cytokines storm. Actually, no proven effective therapies for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exist. Preliminary observations on anticoagulant therapy appear to be associated with better outcomes in moderate and severe COVID-19 patients with signs of coagulopathy and in those requiring mechanical ventilation. The pathophysiology underlying the prothrombotic state elicited by SARS-CoV-2 outlines possible protective mechanisms of antithrombotic therapy (in primis anticoagulants) for this viral illness. The indications for antiplatelet/anticoagulant use (prevention, prophylaxis, therapy) are guided by the clinical context and the COVID-19 severity. We provide a practical approach on antithrombotic therapy management for COVID-19 patients from a multidisciplinary point of view.

Keywords: Anticoagulants; Antiplatelet; Antithrombotic therapy; COVID-19; Coronavirus; Thromboinflammatory syndrome.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Mechanisms of anti-inflammatory effects of anticoagulant (left) and antiplatelet (right) therapies in patients with COVID-19. COX = cyclooxygenase; HSPG = heparan sulfate proteoglycan; MMPs = matrix metalloproteinases; NF-kb = nuclear factor kappa-light-chain-enhancer of activated B cells; SARS-COV-2 = severe acute respiratory syndrome coronavirus 2; TNF = Tumor necrosis factor.
Fig. 2
Fig. 2
Algorithm on antithrombotic therapy in patients with COVID-19. ACS = acute coronary syndrome; APT = antiplatelet therapy; DAPT = dual antiplatelet therapy; DIC = disseminated intravascular coagulation; DOACs = direct oral anticoagulants; INR = international normalized ratio; LMWH = low-molecular-weight heparin; MI = myocardial infarction; SAPT = single antiplatelet therapy; UFH = unfractionated heparin; VTE = venous thromboembolism. ⁎If pharmacological prophylaxis is contraindicated.
See this image and copyright information in PMC

References

    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., Wu Y., Zhang L., Yu Z., Fang M., Yu T., Wang Y., Pan S., Zou X., Yuan S., Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir. Med. 2020;2600:1–7. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Guan W., Ni Z., Hu Y., Liang W., Ou C., He J., Liu L., Shan H., Lei C., Hui D.S.C., Du B., Li L., Zeng G., Yuen K.-Y., Chen R., Tang C., Wang T., Chen P., Xiang J., Li S., Wang J., Liang Z., Peng Y., Wei L., Liu Y., Hu Y., Peng P., Wang J., Liu J., Chen Z., Li G., Zheng Z., Qiu S., Luo J., Ye C., Zhu S., Zhong N. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020:1–13. doi: 10.1056/nejmoa2002032. - DOI - PMC - PubMed
    1. Herold T., Jurinovic V., Arnreich C., Hellmuth J.C., Bergwelt-Baildon M., Klein M., Weinberger T. Level of IL-6 predicts respiratory failure in hospitalized symptomatic COVID-19 patients. MedRxiv. 2020 doi: 10.1101/2020.04.01.20047381. - DOI
    1. Rockx B., Kuiken T., Herfst S., Bestebroer T., Lamers M.M., Oude Munnink B.B., de Meulder D., van Amerongen G., van den Brand J., Okba N.M.A., Schipper D., van Run P., Leijten L., Sikkema R., Verschoor E., Verstrepen B., Bogers W., Langermans J., Drosten C., Fentener van Vlissingen M., Fouchier R., de Swart R., Koopmans M., Haagmans B.L. Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model. Science. 2020;7314 doi: 10.1126/science.abb7314. eabb7314. - DOI - PMC - PubMed
    1. Varga Z., Flammer A.J., Steiger P., Haberecker M., Andermatt R., Zinkernagel A.S., Mehra M.R., Schuepbach R.A., Ruschitzka F., Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;6736:19–20. doi: 10.1016/S0140-6736(20)30937-5. - DOI - PMC - PubMed