Thrombosis and Haemostasis challenges in COVID-19 - Therapeutic perspectives of heparin and tissue-type plasminogen activator and potential toxicological reactions-a mini review.

Laura Mazilu, Niki Katsiki, Taxiarchis Konstantinos Nikolouzakis, Minas I Aslanidis, George Lazopoulos, Dimitrios Kouretas, Aristidis Tsatsakis, Andra-Iulia Suceveanu, Anca-Pantea Stoian, Irinel-Raluca Parepa, Felix Voinea, Adrian Paul Suceveanu, Andreea Letiția Arsene, Bruno Ștefan Velescu, Cosmin Vesa, Cornelia Nitipir

Journal: Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association 2021;148():111974

PMID: 33421462

Free Full Text on PubMed Central View on PubMed

Abstract

The coronavirus disease (COVID)-19 pandemic is a major challenge for the health systems worldwide. Acute respiratory distress syndrome (ARDS), is one of the most common complications of the COVID-19 infection. The activation of the coagulation system plays an important role in the pathogenesis of ARDS. The development of lung coagulopathy involves thrombin generation and fibrinolysis inhibition. Unfractionated heparin and its recently introduced counterpart low molecular weight heparin (LMWH), are widely used anticoagulants with a variety of clinical indications allowing for limited and manageable physio-toxicologic side effects while the use of protamine sulfate, heparin's effective antidote, has made their use even safer. Tissue-type plasminogen activator (tPA) is approved as intravenous thrombolytic treatment. The present narrative review discusses the use of heparin and tPA in the treatment of COVID-19-induced ARDS and their related potential physio-toxicologic side effects. The article is a quick review of articles on anticoagulation in COVID infection and the potential toxicologic reactions associated with these drugs.

Address: Oncology Department, Clinical Emergency Hospital, Faculty of Medicine, "Ovidius" University, Constanța, Romania.; First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece.; Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Greece.; School of Medicine, European University, Cyprus.; Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Medical School, University of Crete, Greece.; Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, 41500, Greece.; Gastroenterology Department, Clinical Emergency Hospital, Faculty of Medicine, "Ovidius" University, Constanța, Romania.; Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. Electronic address: [email protected].; Cardiology Department, Clinical Emergency Hospital, Faculty of Medicine, "Ovidius" University, Constanța, Romania.; Urology Department, Clinical Emergency Hospital, Faculty of Medicine, "Ovidius" University, Constanța, Romania.; Internal Medicine Department, Clinical Emergency Hospital, Faculty of Medicine, "Ovidius" University, Constanța, Romania.; Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.; Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania.; Oncology Department, Elias Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

DOI: 10.1016/j.fct.2021.111974