Curcumin and Coagulopathy in the COVID19 Era
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LETTER TO THE EDITOR
Curcumin and Coagulopathy in the COVID19 Era Padmanaban S. Suresh1
Received: 30 June 2020 / Accepted: 8 July 2020 Ó Association of Clinical Biochemists of India 2020
Dear Editor I read with great interest the article by Manoharan et al., 2020, proposing Curcumin as supportive therapy for COVID-19 disease published in your journal [1]. I want to highlight further the connection between COVID-19 associated coagulopathies and how proposing curcumin will be beneficial in this context from the available literature knowledge. As of Jun 18, 2020, COVID-19 confirmed cases are 8, 242, 999, and 445, 535 deaths globally (World Health Organization). India reports 1, 63, 248 active cases and 12, 573 deaths due to COVID-19 infections (Ministry of Health and family welfare, Govt of India). COVID-19 patients exhibit thrombotic complications apart from sepsis, pneumonia, respiratory failure, etc., One of the characteristic features of COVID-19 disease is the associated coagulopathy with increased circulating D- dimer concentrations. D –dimer is a fibrin degradation product that is present in blood after blood clot fibrinolysis. It is named because it contains fibrin protein, two D fragments joined by a cross-link. Evaluating D-dimer concentrations assist in predicting the mortality in COVID-19 patients, and patients with Ddimer levels [ 1 lg/L on admission were associated with higher mortality [2–4]. There is accumulating evidence of COVID-19 associated coagulopathies as evident by the rising number of research publications in this context. International society of thrombosis and hemostasis proposes an algorithm of measuring D- dimer, prothrombin time, platelet count and fibrinogen in all patients with & Padmanaban S. Suresh [email protected]; [email protected] 1
School of Biotechnology, National Institute of Technology, Calicut, Kerala 673601, India
COVID-19 infection [5]. Markedly raised D-dimer (maybe 3–4 fold increase) prolonged prothrombin time, platelet count (100 9 109/L), fibrinogen (\ 2 g/L) are guiding parameters in the management of COVID-19 patients. Two hypotheses can explain the hypercoagulable state and secondary hyperfibrinolysis in vivo leading to coagulopathies during COVID-19 infection. One is the elevated proinflammatory cytokines (IL-6, IL-1, and TNFa), leading to microvasculature damage and endothelial dysfunction in the lungs, causing hemostasis derangements and pulmonary thrombi. The other alternative hypothesis is the direct or indirect effect of the virus on coagulation pathways causing systemic thrombosis [6]. Antiviral treatments are generally useful and benefit patients; however, treatment strategies that counteract inflammation and coagulopathies may be more promising for COVID-19 patients. Curcumin is a natural compound that exhibits antiviral, antiinflammatory properties, etc. [1], and the research community is continuously making an impressive effort to understand curcumin benefits as an alternative and complementary medicine. Investigators have explored the anti
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