Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research
Mahesh V. Madhavan, Behnood Bikdeli, Aakriti Gupta, David Jiménez, John Burton, Caroline Der‐Nigoghossian, Taylor Chuich, Shayan Nabavi Nouri, Isaac Dreyfus, Elissa Driggin, Sanjum S. Sethi, Kartik Sehgal, Saurav Chatterjee, Walter Ageno, Mohammad Madjid, Yutao Guo, Liang Tang, Yu Hu, Laurent Bertoletti, Jay Giri, Mary Cushman, I. Quéré, Evangelos Dimakakos, C. Michael Gibson, Giuseppe Lippi, Emmanuel J. Favaloro, Jawed Fareed, Alfonso Tafur, Dominic P. Francese, Jaya Batra, Anna Falanga, Kevin J. Clerkin, Nir Uriel, Ajay J. Kirtane, Claire McLintock, Beverley J. Hunt, Alex C. Spyropoulos, Geoffrey D. Barnes, John W. Eikelboom, Ido Weinberg, Sam Schulman, Marc Carrier, Gregory Piazza, Joshua A. Beckman, Martin B. Leon, Gregg W. Stone, Stephan Rosenkranz, Samuel Z. Goldhaber, Sahil A. Parikh, Manuel Monréal, Harlan M. Krumholz, Stavros Konstantinides, Jeffrey I. Weitz, Gregory Y.H. Lip, The Global COVID-19 Thrombosis Collaborative Group
Abstract
Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.