Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
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REVIEW ARTICLE
Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies Alessandro Allegra 1,2
&
Vanessa Innao 1 & Andrea Gaetano Allegra 1 & Caterina Musolino 1
Received: 26 April 2020 / Accepted: 13 July 2020 / Published online: 15 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In October 2019, a viral infectious disease appeared in the city of Wuhan in China. A new betacoronavirus, SARS-CoV-2, has been recognized as the responsible pathogen in this infection. Although coronavirus disease is principally expressed as a pulmonary infection, critical SARS-CoV-2 infection is frequently complicated with coagulopathy, and thromboembolic events are recognizable in several patients. Dehydration, acute inflammatory condition, protracted immobilization during disease, existence of multiple cardiovascular risk factors such as diabetes, obesity or hypertension, previous coronary artery disease, ischemic stroke, peripheral artery disease are frequent comorbidities in SARS-CoV-2 hospitalized subjects, which possibly augment thrombo-embolic risk. However, other causal factors can still be identified such as unrestricted angiotensin II action, the use of immunoglobulins, an increased production of adhesion molecules able to induce vascular inflammation and endothelial activation, complement stimulation, excessive production of neutrophil extracellular traps (NETs), and increased platelet count. Low-molecular-weight heparin should be chosen as early treatment because of its anti-inflammatory action and its ability to antagonize histones and so defend the endothelium. However, several therapeutic possibilities have also been proposed such as fibrinolytic treatment, drugs that target NETs, and complement inhibition. Nevertheless, although the violence of the pandemic may suggest the use of heroic treatments to reduce the frightening mortality that accompanies SARS-CoV-2 infection, we believe that experimental treatments should only be used within approved and controlled protocols, the only ones that can provide useful and specify information on the validity of the treatments. Keywords SARS-Cov-2 . Coagulation . Disseminated intravascular coagulation . Neutrophil extracellular traps . Complement activation . Low-molecular-weight heparin
Introduction Clinical pattern and laboratory findings of thromboembolic events in SARS-CoV-2 patients In October 2019, a viral infectious disease appeared in the city of Wuhan in Hubei Province, China. A new betacoronavirus, SARS-CoV-2, able of human-to-human diffusion, has been
* Alessandro Allegra [email protected] 1
Division of Haematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy
2
COVID Centre AOU Policlinic G. Martino, Messina, Italy
recognized as the responsible pathogen in this infection [1, 2]. At the time of writing, the global pandemic is still present. Latest balance calculates > 8,000,000 people affected world
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