COVID-19 and anticoagulant based therapeutics: Approach with great promise

Dear Editor,

Coronavirus disease 2019 (COVID-19, also known as Severe Acute Respiratory Syndrome Coronavirus 2) has been reported as a novel outbreak since December 2019, and had become pandemic. COVID-19 consists of a single standard RNA which primarily enters the host cell by binding the angiotensin - converting enzyme 2 protein, abundantly expressed in the lung alveolar cells. This suggests that respiratory system is the primary target during the COVID-19 infection [1,2]. Although, COVID-19 is not just a respiratory disease, but has been identified in some patient to mimic coagulopathy conditions such as, thrombosis and disseminated intravascular coagulation (DIC). Outcome based clinical observation revealed that about 46% patients with COVID-19 (globally) suffered coagulopathy condition and elevated levels of D-dimer (>0.5 mg/L) [3,4]. Additionally, COVID-19 infected patients have higher risk of thrombotic disease including acute coronary syndrome, venous thromboembolism or pulmonary embolism, or stroke and increase risk of mortality [5]. Furthermore, an elevated D‐dimer expression and extended prothrombin time have been observed and is significantly associated with poor prognosis in COVID-19 infected patients. D-dimer could be consider as a potent biomarker of fibrin formation and degradation and also can be used as a risk stratification marker in case of COVID-19 infection [6].

Furthermore, COVID-19 infection is highly critical in those patients who is already predisposed to thrombotic disease or are under the process of antithrombotic treatment [7]. Therefore, it has been assumed that suppressed coagulopathy based approach using anticoagulant could be one of the best options to improve the therapeutic possibilities to control COVID-19 pathogenesis and support the quality of life of patients. Anticoagulants such as lopinavir/ritonavir or their combination with Vitamin K antagonists (apixaban, and betrixaban) could be administered orally (Fig. 1 ). Anticoagulant therapy, mainly with low molecular weight heparin boost the survival rate of COVID-19 infected patients with coagulopathy [8]. Additionally, a case series reported by Zhang et. Al, suggests that coagulopathy in COVID-19 infected patients is associated with antiphospholipid antibodies which include anticardiolipin (aCL) and anti–β2‐glycoprotein I (aβ2GPI) [1,2].

Fig. 1.

Anticoagulant based therapeutic could add health benefit to COVID-19 patients via suppressing coagulopathy. Anticoagulant based treatments benefit to the patients suffering from thrombotic and hemorrhagic pathological condition via suppressing the coagulation factors, such as vitamin K antagonists (apixaban, and betrixaban) or anti-heparin or other anticoagulant. Coagulopathy is a most prevalent physiological condition that have been observed in COVID-19 infected patients and is a one of the major causes of mortality around the world. As there are no any specific medication or vaccination strategies evolved to control the COVID-19 infection, the anticoagulant based therapy could be helpful to reduce coagulopathy event and could provide a better therapeutic approach against COVID‐19 pathogenesis.

Presently, majority of people are in lockdown across the world and no specific drug or vaccine have been developed against COVID-19. Looking at the current crisis, most of the measures taken are inclined towards reducing mortality among COVID-19 patients. However, numerous medical and scientific efforts are also under way aiming at the development of a diagnostic and therapeutic tool to combat COVID-19. Focus on procuring more data on epidemiology, pathogenesis, symptoms, pre-clinical and clinical trial and genomics of COVID-19 would provide a holistic approach to eradicate COVID-19 in near future anticoagulant based therapeutic approaches could be one positive and effective medication strategy for better prognosis in severe COVID-19 patients (Fig. 1) and might greatly improve quality of life of COVID-19 patients.