The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) commonly complicates with coagulopathy. A syndrome called Long-COVID-19 is emerging recently in COVID-19 survivors, characterized, in addition to the persistence of symptoms typical of the acute phase, by alterations in inflammatory and co...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/13/10/1904 |
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| author | Domenico Acanfora Chiara Acanfora Marco Matteo Ciccone Pietro Scicchitano Alessandro Santo Bortone Massimo Uguccioni Gerardo Casucci |
| author_facet | Domenico Acanfora Chiara Acanfora Marco Matteo Ciccone Pietro Scicchitano Alessandro Santo Bortone Massimo Uguccioni Gerardo Casucci |
| author_sort | Domenico Acanfora |
| collection | DOAJ |
| description | Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) commonly complicates with coagulopathy. A syndrome called Long-COVID-19 is emerging recently in COVID-19 survivors, characterized, in addition to the persistence of symptoms typical of the acute phase, by alterations in inflammatory and coagulation parameters due to endothelial damage. The related disseminated intravascular coagulation (DIC) can be associated with high death rates in COVID-19 patients. It is possible to find a prothrombotic state also in Long-COVID-19. Early administration of anticoagulants in COVID-19 was suggested in order to improve patient outcomes, although exact criteria for their application were not well-established. Low-molecular-weight heparin (LMWH) was commonly adopted for counteracting DIC and venous thromboembolism (VTE), due to its pharmacodynamics and anti-inflammatory properties. However, the efficacy of anticoagulant therapy for COVID-19-associated DIC is still a matter of debate. Thrombin and Factor Xa (FXa) are well-known components of the coagulation cascade. The FXa is known to strongly promote inflammation as the consequence of increased cytokine expression. Endothelial cells and mononuclear leucocytes release cytokines, growth factors, and adhesion molecules due to thrombin activation. On the other hand, cytokines can activate coagulation. The cross-talk between coagulation and inflammation is mediated via protease-activated receptors (PARs). These receptors might become potential targets to be considered for counteracting the clinical expressions of COVID-19. SARS-CoV-2 is effectively able to activate local and circulating coagulation factors, thus inducing the generation of disseminated coagula. LMWH may be considered as the new frontier in the treatment of COVID-19 and Long-COVID-19. Indeed, direct oral anticoagulants (DOACs) may be an alternative option for both early and later treatment of COVID-19 patients due to their ability to inhibit PARs. The aim of this report was to evaluate the role of anticoagulants—and DOACs in particular in COVID-19 and Long-COVID-19 patients. We report the case of a COVID-19 patient who, after administration of enoxaparin developed DIC secondary to virosis and positivity for platelet factor 4 (PF4) and a case of Long-COVID with high residual cardiovascular risk and persistence of blood chemistry of inflammation and procoagulative state. |
| first_indexed | 2024-03-10T06:09:15Z |
| format | Article |
| id | doaj.art-36d77c6b4f35416a9e1a6164b9662b22 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-10T06:09:15Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-36d77c6b4f35416a9e1a6164b9662b222023-11-22T20:17:50ZengMDPI AGViruses1999-49152021-09-011310190410.3390/v13101904The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical CasesDomenico Acanfora0Chiara Acanfora1Marco Matteo Ciccone2Pietro Scicchitano3Alessandro Santo Bortone4Massimo Uguccioni5Gerardo Casucci6Department of Internal Medicine, San Francesco Hospital, Viale Europa 21, 82037 Telese Terme, ItalyDepartment of Internal Medicine, San Francesco Hospital, Viale Europa 21, 82037 Telese Terme, ItalySection of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, 70124 Bari, ItalySection of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, 70124 Bari, ItalyDivision of Cardiac Surgery, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, ItalyCardiology Unit, San Camillo Hospital, 00152 Rome, ItalyDepartment of Internal Medicine, San Francesco Hospital, Viale Europa 21, 82037 Telese Terme, ItalySevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) commonly complicates with coagulopathy. A syndrome called Long-COVID-19 is emerging recently in COVID-19 survivors, characterized, in addition to the persistence of symptoms typical of the acute phase, by alterations in inflammatory and coagulation parameters due to endothelial damage. The related disseminated intravascular coagulation (DIC) can be associated with high death rates in COVID-19 patients. It is possible to find a prothrombotic state also in Long-COVID-19. Early administration of anticoagulants in COVID-19 was suggested in order to improve patient outcomes, although exact criteria for their application were not well-established. Low-molecular-weight heparin (LMWH) was commonly adopted for counteracting DIC and venous thromboembolism (VTE), due to its pharmacodynamics and anti-inflammatory properties. However, the efficacy of anticoagulant therapy for COVID-19-associated DIC is still a matter of debate. Thrombin and Factor Xa (FXa) are well-known components of the coagulation cascade. The FXa is known to strongly promote inflammation as the consequence of increased cytokine expression. Endothelial cells and mononuclear leucocytes release cytokines, growth factors, and adhesion molecules due to thrombin activation. On the other hand, cytokines can activate coagulation. The cross-talk between coagulation and inflammation is mediated via protease-activated receptors (PARs). These receptors might become potential targets to be considered for counteracting the clinical expressions of COVID-19. SARS-CoV-2 is effectively able to activate local and circulating coagulation factors, thus inducing the generation of disseminated coagula. LMWH may be considered as the new frontier in the treatment of COVID-19 and Long-COVID-19. Indeed, direct oral anticoagulants (DOACs) may be an alternative option for both early and later treatment of COVID-19 patients due to their ability to inhibit PARs. The aim of this report was to evaluate the role of anticoagulants—and DOACs in particular in COVID-19 and Long-COVID-19 patients. We report the case of a COVID-19 patient who, after administration of enoxaparin developed DIC secondary to virosis and positivity for platelet factor 4 (PF4) and a case of Long-COVID with high residual cardiovascular risk and persistence of blood chemistry of inflammation and procoagulative state.https://www.mdpi.com/1999-4915/13/10/1904DOACsCOVID-19anticoagulantsLMWHPARsLong-COVID-19 |
| spellingShingle | Domenico Acanfora Chiara Acanfora Marco Matteo Ciccone Pietro Scicchitano Alessandro Santo Bortone Massimo Uguccioni Gerardo Casucci The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases Viruses DOACs COVID-19 anticoagulants LMWH PARs Long-COVID-19 |
| title | The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases |
| title_full | The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases |
| title_fullStr | The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases |
| title_full_unstemmed | The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases |
| title_short | The Cross-Talk between Thrombosis and Inflammatory Storm in Acute and Long-COVID-19: Therapeutic Targets and Clinical Cases |
| title_sort | cross talk between thrombosis and inflammatory storm in acute and long covid 19 therapeutic targets and clinical cases |
| topic | DOACs COVID-19 anticoagulants LMWH PARs Long-COVID-19 |
| url | https://www.mdpi.com/1999-4915/13/10/1904 |
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