COVID-19 Early Stage Disease Progression and Anticoagulants: Investigation Rationale, Challenges and Difficulties

Abstract

COVID-19 pandemic has changed the world and will keep us breathless for some time, still. Soon after the start of the disease in Wuhan and later in Italy and Spain, it became clear, that thromboses of arteries and veins played an important role in the severe cases.

The present article parts from the hypothesis, that patients suffering from COVID-19 could benefit from low molecular weight heparin (LMWH) in prophylactic dose or aspirin, if applied in early stages of the disease. LMWH prevent venous and ASS arterial thromboses. Different study approaches are proposed in the article. The difficulties to run a study like this, applying anti aggregation or anticoagulation to patients in early stages of SARS-CoV-2 infection are discussed, especially considering, that the medicaments are cheap and no industry will have any interest in sponsoring.

Most of the studies in corona disease are run in hospitals, where everybody fights to save critically ill patients. Very little investigation was done until now in pre-clinic patients. Mostly, because in lot of countries the testing was performed when admitted to hospital. Perhaps – even without a study – the evidence of thrombosis in the disease progression should lead to a D-Dimer testing after infection. The German Society of Thrombosis and Haemostasis Research (GTH) has recommended to consider administering heparin generously in COVID-19 ambulatory patients already in April 2020. Thus, in patients with little symptoms it would be possible to start early with LMWH in prophylactic dose in case of increased D-Dimer.

Key words

Corona pandemic - COVID-19 - thrombosis - symptom prevention - heparin - ASA

Schlüsselwörter

Corona - Thrombose - Vorbeugung der Symptomentwicklung - Pandemie COVID-19 - Heparin - ASS

Publikationsverlauf

Artikel online veröffentlicht:
03. August 2020

• References

• 1 Guan WJ, Ni ZY, Hu Y. et al Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720 . doi:10.1056/NEJMoa2002032. Epub 2020 Feb 28. PMID: 32109013
• 2 Huang C, Wang Y, Li X. et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506
• 3 Tang N, Li D, Wang X. et al Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; [Epub ahead of print] DOI: 10.1111/jth.14768.
• 4 Klok FA, Kruip MJHA, van der Meer NJM. et al Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147 . doi:10.1016/j.thromres.2020.04.013. Epub 2020 Apr 10
• 5 Cui S, Chen S, Li X. et al Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; [Epub ahead of print] DOI: 10.1111/jth.14830.
• 6 Tang N, Bai H, Chen X. et al Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; [Epub ahead of print] DOI: 10.1111/jth.14817.
• 7 Thachil J, Tang N, Gando S. et al ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020; [Epub ahead of print] DOI: 10.1111/jth.14810.
• 8 Casini A, Alberio L, Angelillo-Scherrer A. et al Thromboprophylaxis and laboratory monitoring for in-hospital patients with COVID-19 – a Swiss consensus statement by the Working Party Hemostasis. Swiss Med Wkly 2020; 150: w20247
• 9 Marietta M, Ageno W, Artoni A. et al COVID-19 and haemostasis: a position paper from Italian Society on Thrombosis and Haemostasis (SISET). Blood Transfus 2020; [Epub ahead of print] DOI: 10.2450/2020.0083-20.
• 10 Belcaro G, Corsi M, Agus GB, Corneli U. Thromboprophylaxis prevents thrombotic events in home managed COVID patients. A Registry Study – personal information of author with permission to spread the information, submitted for publication.
• 11 GTH, Aktualisierte Empfehlungen zur Thromboseprophylaxe bei SARS-CoV-2 (COVID-19). http://gth-online.org/wp-content/uploads/2020/04/Aktualisierte-GTH-Empfehlungen-COVID-19-1.pdf