Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India.
Expert Rev Anti Infect Ther. 2021 Nov;19(11):1397-1413. doi: 10.1080/14787210.2021.1915129. Epub 2021 Apr 19.
SARS-CoV-2, the causative agent of COVID-19, attacks the immune system causing an exaggerated and uncontrolled release of pro-inflammatory mediators (cytokine storm). Recent studies propose an active role of coagulation disorders in disease progression. This hypercoagulability has been displayed by marked increase in D-dimer in hospitalized patients.
This review summarizes the pathogenesis of SARS-CoV-2 infection, generation of cytokine storm, the interdependence between inflammation and coagulation, its consequences and the possible management options for coagulation complications like venous thromboembolism (VTE), microthrombosis, disseminated intravascular coagulation (DIC), and systemic and local coagulopathy. We searched PubMed, Scopus, and Google Scholar for relevant reports using COVID-19, cytokine storm, and coagulation as keywords.
A prophylactic dose of 5000-7500 units of low molecular weight heparin (LMWH) has been recommended for hospitalized COVID-19 patients in order to prevent VTE. Treatment dose of LMWH, based on disease severity, is being contemplated for patients showing a marked rise in levels of D-dimer due to possible pulmonary thrombi. Additionally, targeting PAR-1, thrombin, coagulation factor Xa and the complement system may be potentially useful in reducing SARS-CoV-2 infection induced lung injury, microvascular thrombosis, VTE and related outcomes like DIC and multi-organ failure.
导致 COVID-19 的 SARS-CoV-2 攻击免疫系统，导致促炎介质（细胞因子风暴）的过度和失控释放。最近的研究提出凝血障碍在疾病进展中起积极作用。这种高凝状态表现在住院患者 D-二聚体明显增加。
本文综述了 SARS-CoV-2 感染的发病机制、细胞因子风暴的产生、炎症和凝血的相互依存关系、其后果以及静脉血栓栓塞症（VTE）、微血栓形成、弥散性血管内凝血（DIC）、全身和局部凝血障碍等凝血并发症的可能治疗选择。我们使用 COVID-19、细胞因子风暴和凝血作为关键字，在 PubMed、Scopus 和 Google Scholar 上搜索了相关报告。
建议对住院的 COVID-19 患者预防性使用 5000-7500 单位低分子量肝素（LMWH），以预防 VTE。根据疾病严重程度，对于因可能的肺血栓形成而 D-二聚体水平明显升高的患者，考虑使用 LMWH 治疗剂量。此外，靶向 PAR-1、凝血酶、凝血因子 Xa 和补体系统可能有助于减少 SARS-CoV-2 感染引起的肺损伤、微血管血栓形成、VTE 及相关结局如 DIC 和多器官衰竭。
