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Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies

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 f...

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Autores principales: Allegra, Alessandro, Innao, Vanessa, Allegra, Andrea Gaetano, Musolino, Caterina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363407/
https://www.ncbi.nlm.nih.gov/pubmed/32671455
http://dx.doi.org/10.1007/s00277-020-04182-4
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author Allegra, Alessandro
Innao, Vanessa
Allegra, Andrea Gaetano
Musolino, Caterina
author_facet Allegra, Alessandro
Innao, Vanessa
Allegra, Andrea Gaetano
Musolino, Caterina
author_sort Allegra, Alessandro
collection PubMed
description 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.
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spelling pubmed-73634072020-07-16 Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies Allegra, Alessandro Innao, Vanessa Allegra, Andrea Gaetano Musolino, Caterina Ann Hematol Review Article 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. Springer Berlin Heidelberg 2020-10-07 2020 /pmc/articles/PMC7363407/ /pubmed/32671455 http://dx.doi.org/10.1007/s00277-020-04182-4 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Allegra, Alessandro
Innao, Vanessa
Allegra, Andrea Gaetano
Musolino, Caterina
Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title_full Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title_fullStr Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title_full_unstemmed Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title_short Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies
title_sort coagulopathy and thromboembolic events in patients with sars-cov-2 infection: pathogenesis and management strategies
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363407/
https://www.ncbi.nlm.nih.gov/pubmed/32671455
http://dx.doi.org/10.1007/s00277-020-04182-4
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