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COVID-19: The crucial role of blood coagulation and fibrinolysis

The overflow of studies in the recent literature on COVID-19 often gives provisional or contradictory results and therefore deserves pauses of reflection and reconsideration. In fact, knowledges of pathophysiology of this new disease are still in development and hence originate discussions and inter...

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Autor principal: Coccheri, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398289/
https://www.ncbi.nlm.nih.gov/pubmed/32748128
http://dx.doi.org/10.1007/s11739-020-02443-8
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author Coccheri, Sergio
author_facet Coccheri, Sergio
author_sort Coccheri, Sergio
collection PubMed
description The overflow of studies in the recent literature on COVID-19 often gives provisional or contradictory results and therefore deserves pauses of reflection and reconsideration. In fact, knowledges of pathophysiology of this new disease are still in development and hence originate discussions and interpretations. Regarding the role of blood coagulation and fibrinolysis, these mechanisms should be considered as crucial especially in severe cases. It is proposed to consider two distinct phenotypes of thrombotic manifestations: the current “thromboembolic type” also occurring in other kinds of sepsis, and the diffuse micro-thrombotic type, prevailing in the lungs but sometimes extending to other organs. Both types can induce severe disease and are potentially lethal. The micro-thrombotic pattern, more specific for COVID-19, results from a massive activation of coagulation strictly coupled with a hyper-intense inflammatory and immune reaction. This results in widespread occlusive thrombotic micro-angiopathy with destruction of alveoli and obstructive neoangiogenesis. The involvement of fibrinolysis, often neglected, confers a double faceted process of activation/inhibition, finally conducive to a fibrinolytic shutdown that reinforces persistence of micro-thrombi. Considering these peculiar mechanisms, it seems evident that both prophylactic and therapeutic effects of current anti-thrombotic drugs cannot be taken for granted and need therefore new specific and rigorous controlled trials.
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spelling pubmed-73982892020-08-04 COVID-19: The crucial role of blood coagulation and fibrinolysis Coccheri, Sergio Intern Emerg Med IM-Point of view The overflow of studies in the recent literature on COVID-19 often gives provisional or contradictory results and therefore deserves pauses of reflection and reconsideration. In fact, knowledges of pathophysiology of this new disease are still in development and hence originate discussions and interpretations. Regarding the role of blood coagulation and fibrinolysis, these mechanisms should be considered as crucial especially in severe cases. It is proposed to consider two distinct phenotypes of thrombotic manifestations: the current “thromboembolic type” also occurring in other kinds of sepsis, and the diffuse micro-thrombotic type, prevailing in the lungs but sometimes extending to other organs. Both types can induce severe disease and are potentially lethal. The micro-thrombotic pattern, more specific for COVID-19, results from a massive activation of coagulation strictly coupled with a hyper-intense inflammatory and immune reaction. This results in widespread occlusive thrombotic micro-angiopathy with destruction of alveoli and obstructive neoangiogenesis. The involvement of fibrinolysis, often neglected, confers a double faceted process of activation/inhibition, finally conducive to a fibrinolytic shutdown that reinforces persistence of micro-thrombi. Considering these peculiar mechanisms, it seems evident that both prophylactic and therapeutic effects of current anti-thrombotic drugs cannot be taken for granted and need therefore new specific and rigorous controlled trials. Springer International Publishing 2020-08-03 2020 /pmc/articles/PMC7398289/ /pubmed/32748128 http://dx.doi.org/10.1007/s11739-020-02443-8 Text en © Società Italiana di Medicina Interna (SIMI) 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 IM-Point of view
Coccheri, Sergio
COVID-19: The crucial role of blood coagulation and fibrinolysis
title COVID-19: The crucial role of blood coagulation and fibrinolysis
title_full COVID-19: The crucial role of blood coagulation and fibrinolysis
title_fullStr COVID-19: The crucial role of blood coagulation and fibrinolysis
title_full_unstemmed COVID-19: The crucial role of blood coagulation and fibrinolysis
title_short COVID-19: The crucial role of blood coagulation and fibrinolysis
title_sort covid-19: the crucial role of blood coagulation and fibrinolysis
topic IM-Point of view
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398289/
https://www.ncbi.nlm.nih.gov/pubmed/32748128
http://dx.doi.org/10.1007/s11739-020-02443-8
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