COVID-19 and immunothrombosis: emerging understanding and clinical management.
TL;DR: In this paper, the authors report outcomes of intermediate and therapeutic anticoagulation in hospitalised patients with varying severities of severe COVID-19 disease, including optimal dosing and associated bleeding risks.
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Abstract: The COVID-19 pandemic has been the most significant health crisis in recent global history. Early studies from Wuhan highlighted COVID-19-associated coagulopathy and a significant association with mortality was soon recognised. As research continues across the world, more evidence is emerging of the cross-talk between the innate immune system, coagulation activation and inflammation. Immunothrombosis has been demonstrated to play a key role in the pathophysiology of severe COVID-19, with extracellular histones and neutrophil extracellular traps detected in the plasma and cardiopulmonary tissues of critically ill patients. Targeting the components of immunothrombosis is becoming an important factor in the treatment of patients with COVID-19 infection. Recent studies report outcomes of intermediate and therapeutic anticoagulation in hospitalised patients with varying severities of COVID-19 disease, including optimal dosing and associated bleeding risks. Immunomodulatory therapies, including corticosteroids and IL-6 receptor antagonists, have been demonstrated to significantly reduce mortality in COVID-19 patients. As the pandemic continues, more studies are required to understand the driving factors and upstream mechanisms for coagulopathy and immunothrombosis in COVID-19, and thus potentially develop more targeted therapies for SARS-CoV-2 infection, both in the acute phase and in those who develop longer-term symptom burden.
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Citations
Effect of Antiplatelet Therapy on Survival and Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial.
Charlotte Bradbury,Patrick R. Lawler,Simon J. Stanworth,Bryan J. McVerry,Zoe McQuilten,Alisa Higgins,Paul R Mouncey,Farah Al-Beidh,Kathryn M Rowan,Lindsay R. Berry,Elizabeth Lorenzi,Ryan Zarychanski,Yaseen M. Arabi,Djillali Annane,Abi Beane,Wilma van Bentum-Puijk,Zahra Bhimani,Shailesh Bihari,Marc J. M. Bonten,Frank M. Brunkhorst,Adrian Buzgau,Meredith Buxton,Marc Carrier,Allen C. Cheng,Matthew E. Cove,Michelle A. Detry,Lise J Estcourt,Mark Fitzgerald,Timothy D. Girard,Ewan C. Goligher,Herman Goossens,Rashan Haniffa,Thomas Hills,David T. Huang,Christopher M. Horvat,Beverley Hunt,Nao Ichihara,Francois Lamontagne,Helen L. Leavis,Kelsey Linstrum,Edward Litton,John C. Marshall,Daniel F. McAuley,Anna McGlothlin,Shay McGuinness,Saskia Middeldorp,Stephanie K. Montgomery,Susan C. Morpeth,Srinivas Murthy,Matthew D. Neal,Alistair Nichol,Rachael Parke,Jane Parker,Luis Reyes,Hiroki Saito,Marlene Santos,Christina Saunders,Ary Serpa-Neto,Christopher W. Seymour,Manu Shankar-Hari,Vanessa Singh,Timo Tolppa,Alexis F. Turgeon,Anne Turner,Frank L. van de Veerdonk,Cameron M. Green,Roger J. Lewis,Derek C. Angus,Colin McArthur,Scott M. Berry,Lennie P. G. Derde,Steve Webb,Anthony C. Gordon +72 more
TL;DR: Among critically ill patients with COVID-19, treatment with an antiplatelet agent, compared with no antiplatelets, had a low likelihood of providing improvement in the number of organ support-free days within 21 days, and was statistically pooled for further analysis.
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Thromboembolic prevention and anticoagulant therapy during the COVID-19 pandemic: updated clinical guidance from the anticoagulation forum
Geoffrey D. Barnes,Allison Burnett,Arthur Allen,Jack Ansell,Marilyn Slavin Blumenstein,Nathan P. Clark,Mark Crowther,William E. Dager,Steven Deitelzweig,Stacy Ellsworth,David A. Garcia,Scott Kaatz,Leslie Raffini,Anita Rajasekhar,A V Beek,Tracy Minichiello +15 more
TL;DR: In this paper , the authors provide updated guidance for the use of anticoagulant therapies in patients with COVID-19 from the Anticoagulation Forum, the leading North American organization of antioagulation providers.
Prevention and management of thrombosis in hospitalised patients with COVID-19 pneumonia.
TL;DR: In this article, the authors provide a summary of the pathophysiology of thrombosis and associated laboratory and clinical findings, and highlight key considerations in the management of coagulopathy in hospitalised patients with severe COVID-19, including coagulation assessment, identification of THC complications, and use of antithrombotic prophylaxis and therapeutic anticoagulation.
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C-reactive protein, immunothrombosis and venous thromboembolism
Carolin Dix,Johannes Zeller,Hannah Stevens,Steffen U. Eisenhardt,Karen S. Cheung Tung Shing,Tracy L. Nero,Craig J. Morton,Michael W. Parker,Karlheinz Peter,James D. McFadyen +9 more
TL;DR: The prospect that CRP may play a role in promoting VTE formation in the context of concurrent inflammation is raised, however, further investigation is required to unravel whether CRP plays a direct role in the pathogenesis of VTE.
Alpha‐2‐macroglobulin in hemostasis and thrombosis: An underestimated old double‐edged sword
TL;DR: The known functions of A2M are summarized, a brief overview about diseases, and the roles of this antiproteinase in hemostasis and thrombosis are focused on.
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Ana Blasco,María José Coronado,Fernando Hernández-Terciado,Paloma Martín,Ana Royuela,E. Ramil,Diego García,Javier Goicolea,Maria Del Trigo,Javier Ortega,Juan Manuel Escudier,Lorenzo Silva,Carmen Bellas +12 more
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TL;DR: Prolonged aPTT in patients with Covid-19 had a prolonged activated partial-thromboplastin time and the cause was lupus anticoagulant...